HomeMy WebLinkAboutPERMIT APP - 9-18-20All 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
PERMITTYPE:GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 1549 NW BUTTONBUSH CIR
Property Tax ID #: 4426-815-0035-000-6 Lot No.
Site Plan Name: BROCKOB Block No.
Project Name: BROCKOB
DETAILED DESCRIPTION OF WORK:
EXTERIOR LP GAS TANK AND LINES
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2300 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameAlbert E Brockob, Linda Brockob
Name: Cheyenne Ellison
Address: 1549 NW Buttonbush Cir
Company: Elite Gas Contractors
City: palm City State: _
Zip Code: 34990 Fax:(772)220-1829
Phone No. (772)220-9678
Address: 2130 Poma Drive
City: Palm City State: FL
Zip Code: 34990 Fax: (772)220-1829
Phone No(772)220-9678
E-Mail:emcintosh@elitegasco.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailemcintosh@elitegasco.com
State or County License 18361
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ATTORNEY
Signature of Ow er/ Lessee/Contractor as Agent for Owner
Signature of Contra'r/License Holder
STATE OF FLORIQqA
COUNTY OF /14
_qb
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this J1 day of Ath be—,, 20�% by
The forgoing instrument was acknowledged before me
this j1day ofSGIo� r , 20 c7Cby
Name of erson making st ement.
Name of pe on making tement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced_
Produced
( ignature o Nota
oX Notary public State of Floritla
Desiree
Commission No. r'(lIjtosh
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esiree N McIntosh
�Ommission No.yCOmmis�beat1283399
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