HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 09/16/2020 Permit Number:
SM [Luau,
�� `� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
PERMIT APPLICATION FORIP GAS LINE
PROPS INIP 0�*E' NT LOCATION:
Address: 16183 Carlton Adams Road, Fort Pierce, Florida 34945
Property Tax ID#: 2236-700-0009-000-3 Lot No.7
Site Plan Name: Block No.
Project Name: Swain gas line
DETA L1b DESCRIPTION OF WORK:
Install 25' of poly gas line from existing UG tank to generator
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFO SON:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank YGas Piping Shutters Windows/Doors Pond
Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: S 795.00 Utilities- —Sewer r Septic Building Height:
O A�LESSEE: CONTRACTOR:
Name William Swain Name:Manuel Tobar
Address:16183 Carlton Adams Road Company;ThompsonGas LLC
City: Fort Pierce State: L Address:1786 SW Biltmore St
Zip Code: 34945 Fax: City: Port St Lucie State:FL
Phone No.772-807-8290 Zip Code: 34984 Fax: 772-206-3606
E-Mail: Phone N0772-777-8133
Fill in fee simple Title Holder on next page(if different E-Mailmtobar@thompsongas.com i
from the Owner listed above) State or County LicenseLQ32270 —�
i
L
of construction is 2500 or more,a RECORDED Notice of Commencement is required.
of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM ENTA(Ct?NSTRUCTIO 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:
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/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFStLucie COUNTY OF St Lucie
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 16 day of September 12020 by this 16 day of September , 2020 by
Manuel Tobar Manuel Tobar
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
(Signature Vlotary P - (Signature s tary Publi Sj pf Florida)EMILYGALEN
�AY;y•.. EMI Y GALEN
?',•'' �`•:�=. �,,: MY COMMISSION#GG 1&5d62
Commission No. 165462! .i MY CO%��P1.S ON#GG 16545? lssasz I'�''.�•+` t
EXPiRES'��cember5,202.1 Commission No. N, Ex�&6Blpecember5,2021
r I 'y'FpF Fy°a; Bonded Thru Notary Public Unddtwrlterd "? Bonded Thru Notary Public Undetwr tern
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE _F
COMPLETED
Rev. 5