HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential x
PERMIT APPLICATION FOR: gas
PROPOSED IMPROVEMENT LOCATION:
Address: 6789 S Indian River Dr
Property Tax ID #: 3412-140-0001-0002 Lot No.
Site Plan Name: haag Block No.
Project Name: haag
DETAILED DESCRIPTION OF WORK: I
install 500g ug tank & line to generator and water heater
New Electrical Meter
CONS
Second Electrical Meter
TION:
Additional work to be performed under this permit– check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 3495.00
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Travis Haag
Name: Manuel Tobar
Address: 6789 S Indian Dr
Company: Thompson Gas LLc
City: Ft Pierce State: _
Address: 1786 SW Biltmore St
Zip Code: 34983 Fax:
City: Pt St Lucie State: FL
Phone No. 772-834-4940
Zip Code: 34984 Fax:
E -Mail: travishaag@gmail.com
Phone No 772-777-8133
Fill in fee simple Title Holder on next page ( if different
E -Mail mtobar@thompsongas.com
from the Owner listed above)
State or County License Ig32270
If value of construction is 2500 or more, a KtCUKUtU Notice OT Lommencemeni is requlreu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
uwNEK/ CON TRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencingwork or recordina vour Notice of Commencement
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY ` �-
STATE OF FLORID
Lc
OF ;, l,c , -
COUNTY OF S� ,c-) r --
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subribed before me of
_ Physical Presence or -/ Online Notarization
Physical Presence Dr Online Notarization
this day off 2020 by
thisl 44 day of 2020 by
3L C'u-
) CI YI (J rt'
r
`U
Name of person making statement.
Name of person makin statement.
Personally Known OR Produced Identification
Personally Known ; OR Produced Identification
Type of Identification
Type of Identification
1 -'
Produced
Produced
(Signature of Notary Public- State of Florida)
r
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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I-. If v/w
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BIN