HomeMy WebLinkAboutPERMIT APP - 11-3-20All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential X
PERMITTYPE:GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 2756 BROCKSMITH RD
Property Tax ID q: 2320-501-0060-000-5 Lot No.8
Site Plan Name: SAMPSOM Block No. 4
Project Name: SAMPSON
DETAILED DESCRIPTION OF WORK:
ADDING NEW TANKLESS WATER HEATER AT EXISTING GAS STUB
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: $ 1500
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Richard A Sampson
Name: Cheyenne Ellison
Address: 2170 SW Conant AVE
Company: Elite Gas Contractors
City: Port St Lucie State: _
Zip Code: 34953 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
u vdiue or conscrucnon is ?vuu or more, a 11MUMutu 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:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
COUNTYOF Mwri—ln
Address:
The forgoing instrument was acknowledged before me
City:
Zip: Phone
State: _
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of Identification
Address:
Pro ced
City:
(S gnature
City:
on Io Notary Public State of Florida
Zip: Phone:
Commission 0. Desiree N Mclnlosh,-
)
Zip: Phone:
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Expo 7 1112022
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 rnmmFNrFMFNT "
Signature Owner/ Lessee/Contractor as Agent for Owner
Signature oontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF McKr+;n
COUNTYOF Mwri—ln
The forgoing instrument was acknowledged before me
this aWdayof Obeg-
The forgoing instrument was acknowledged before me
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this-aSdayof tA)C*019-C.✓' 204A&y
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"Name
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Name o erson makin statement.
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Name ofpr�rson makin statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Pro ced
gnatu o- t tte Qutfl%IO � Florida
(S gnature
a9 Desiree N McIntosh
on Io Notary Public State of Florida
Commission No. M CommisslonfiS�?p3399R
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED