HomeMy WebLinkAboutBuilding permit app"N --t* Q00 q -
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE:GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 4920 Conley PL
Property Tax ID #: 1313-131-0009-000-0 Lot No.
Site Plan Name: MOORE Block No.
Project Name: MOORE
DETAILED DESCRIPTION OF WORK:
GENERATOR CONNECT ONLY
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 400 Utilities: _ Sewer _ Septic
_ Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameJoseph Moore
Name:Cheyenne Ellison
Address:63 Flores del Norte
Company: Elite Gas Contractors
City: Fort Pierce State: _
Zip Code: 34951 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-Mail emcintosh@elitegasco.com
State or County License 18361
If value of construction is $2500 or more, a RECORDED Notice of commencement is requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
EER: Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature c/Owner/ Lessee/Contractor as Agent for Owner I Signature
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF Q h fin COUNTY OF A40 I— fi'rJ
The for oing instrument was acknowledged before me
this May of _ OC74010P r. 20p&by
Name of p6rson making st tement.
Personally Known OR Produced Identification
Type of Identification
The for oing instrument was acknowledged before me
this day of d!'YlbLpy. 20a-tay
Name of per0n makings ss tement.
Personally Known V OR Produced Identification
Type of Identification
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Commission No.
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