HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8/10/2020 Permit Number:
CI LUTCM
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
PERMIT APPLICATION FOR: Install 3-1000 Gal. U/G LP Tank & gas piping
PROPOSED IMPROVEMENT LOCATION:
Address: 15355 Skyking Drive
Property Tax ID #: 4224-501-0074-000-7
Site Plan Name: Humphries, Neal L.
Project Name: Humphries, Neal L.
DETAILED DESCRIPTION OF WORK:
Install 3-1000 gallon underground/mounded LP tanks with exterior/underground gas piping
for Primary Generator permit 1911-0449
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: $ 9,000.00
Generator
Sq. Ft. of First Floor:
Lot No.74
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer —Septic Building Height:
OWN ERAESSEE:
CONTRACTOR:
Name Humphries, Neal L.
Name: Brian M. Critoph
Address:15355 Skyking Drive
Company: C&C Diversified Services
City: Port St Lucie, FL State: _
Zip Code: 34987 Fax:
Phone No.631-357-9696
Address: 7954 SW Jack James Drive
City: Stuart State: FL
Zip Code: 34997 Fax: 772-266-4679
Phone No 772-266-4680
E-Mail:hover0l@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Susan@ccdiversifiedgas.com
State or County License 1_121079
It value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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
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 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/ essee/Contractor as Agent for Owner
Signature of ContractoF/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Florida
COUNTY OF Ficrida
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
X Physical Presence or Online Notarization
this 18 day of september 2020 by
this 18 day of September 2020 by
Brian M. Critoph
Brian M. Critoph
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced 71.
W. PADGETT
Y" GETT
ignature of Notary rli t ate
{Si ature of Notary (g;c a
�a= E PIRES: January 21 2024
1 January 21, 2024
�r�.P
Bonded Th of Auf�lic Underwriters
Commission No.
F ;°', Bonded Th 2t Public Underwriters
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.