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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3��.��� Permit Number: VI0�•C1d y�J
; _. , L.,;_� _ .:.� RECE ;AR 02 2017
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
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION:
Address: 2511 NW HOLLYBERRY LN PALM CITY FL 33490
Legal Description: HARBOUR RIDGE PLAT NO 1 LOT 13(OR 3951-1634)
Property Tax ID#: 4436-601-0013-000-0 Lot No.13
Site Plan Name: 2511 NW HOLLYBERRY Block No.
Project Name: 2511 NW HOLLYBERRY
Setbacks Front 10 Back: 10 Right Side: 10 Left Side: 10
DETAILED DESCRIPTION OF WORK:"
120 GAL'-6K W- 0-6109 _ LP GAS TANK AND EXTERIOR LINE TO WATER HEATER, GRILL,
STOVE AND FIREPLACE.
CONSTRUCTION INFORMATION:
Acid itional work to be nertormed under t ispermit—check all appy:
F]HVAC Lr J Gas Tank W]Gas Piping _Shutters a Windows/Doors
11 Electric Plumbing U Sprinklers E Generator R Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ $3,135.28 Utilities: Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name DANNEL SCHWARTZ Name: JONATHAN HURD
Address:2511 NW HOLLYBERRY LN Company: FERRELLGAS
City: PALM CITY State:FL Address: 3232 SE DIXIE HWY
Zip Code: 33490 Fax:N/A City: STUART State:FL
Phone No.772-781-3390 Zip Code: 34997 Fax: 772-287-3456
E-Mail:DANNELI@SHIRSHALOM.ORG Phone No. 772-287-4330
Fill in fee simple Title Holder on next page(if different E-Mail: K ATRINABELANGER@FERRELLGAS.COM
from the Owner listed above) State or County License: 01237
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN ILAW 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:
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 jobsite
before the first ' spection. If you intend to obtain financing, consult with lender or an attorney before
commencin k or recording our Notice of Commencement.
S
S' re of Owner/Lessee/Contractor as Agent for Owner Siture of Co actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF lnaf},n COUNTY OF to ac4-cti
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this).day ofFCb�uar�j 20 12 by this-V kl day of_ rt4,,41,1�, ,20 I1 by
1 J OVIA AA 14vrc Oy�a1M�n 1-Iuccl
(Name of person acknowledging) (Name of person acknowledging)
IX aAvv,-4
(Signaturef Notary Public- tate of Flor' a) (Signatur4 of Notary Publi6- te ofFlori a)
Personally Known_�OR Produced Ide��ll{I�tPllf)�j� Personally Known OR Produced Identification
Type of Identification Produced ��� jai, Type of Identification Produced
Commission No. F6LAE/Oc �� l�� Zags Commission No. /=F9'�sYoS` (�'� �s��20
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Revised 07/15/2014 P v eL� .,
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