HomeMy WebLinkAboutST Lucie Building PermitAll 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 Commercial Residential Residen
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 5411 Place Lake DR
Property Tax ID #: 1312-502-009P41-000-7
Site Plan Name.-mu.",u t
Project Name:
Lot No.193
Block No.
DETAILED DESCRIPTION OF WORK:
Installing a 500 gallon Underground propane tank and running 60 feet of 3/4 inch poly to the generator.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be perfor ed under this permit— check all that apply:
Mechanical - Gas Tank _ Gas Piping Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 00
Sq. Ft. of First Floor:
Utilities
OWNER/LESSEE:
Name David ,(Td�fA
Address:5411 Place Lake Dr
City: Fort Pierce State: _
Zip Code: 34951 Fax:
Phone No.407-816-9000
E-Mail:
Fill in fee simple Title Holder on next page ( if different
RE
liM 111C001� C
Windows/Doors Pond
Roof t Pitch
: _Sewer _ Septic Building Height:
CONTRACTOR:
Name: Manuel Tobar
Company: Thompson Gas
Address:1768 Biltmore ST
City: Port St Lucie St te: FL
Zip Code: 34984 Fax:
Phone N0772-777-8133
E-Mail mtobar@thompsongas.com
51& v wal �iwh LG32270
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not A
Name:
plicable
Address:
Address:
City:State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR 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 subje t structure
which is in conflict with any applicable Home Owners Assoaation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with tour Home QwnerS
oGOnS efatl0n Ot�rn �o�t Idohorob � r
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments,
Ul
Qo1p rom �n or�o n� � � �oh�uNN�H�u ��u��u�! Nedw1 addi�ions,
acce55or� ��ruc�ur�S, s�mmn� poo s, f oncos, Walls, si hs scNQQh rooms and 8�ceSsor
� uses io another non-resIident a1 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 commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY 0FSTLucie
SwVnto (or affirmed) and subscribed before me of
P sical PrUence or Online Notarization
this 1 day off ° 2020 by
Name of person making s
sttatement. °
Personally Known `Z OR Produced Identification
Type of Identification
P 4--i
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OFSTLUd.
Sworn o (or affirmed) and subscribed before me of
hysical Presence or Online Notarization
this day of 2020 by
Name of person making s'f'atement.
Personally Known kl�OR Produced Identification
Type of Identification