HomeMy WebLinkAboutBuilding Permit Application-PollyAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/8/2020 Permit Number:
L 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) 462-1S78
PERMIT APPLICATION FOR: Install LP Gas piping
PROPOSED IMPROVEMENT LOCATION:
Address: 13410 NW Wax Myrtle Trail
Property Tax M #: 4436-601-0034-000-3
Site Plan Name: Carta, Stephen & Polly
Project Name: Carta, Stephen & Polly
DETAILED DESCRIPTION OF WORK:
Install exterior/underground LP Gas piping for generator
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential X
Lot No.34
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical _... Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1,000.00
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Carta, Stephen & Polly
Name: Brian M. Critoph
Address:13410 NW Wax Myrtle Trail
Company: C&C Diversified Services
City: Palm City, FL State: _
Zip Code: 34990 Fax:
Phone -No. U1_ 309-0521
Address: 7954 SW ,lack James Drive
City: Stuart State: FL
Zip Code: 34997 Fax: 772-266-4679
Phone No 772-266-4680
E-Mail:
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 L121079
IT Value oT construction IS ZSUU 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:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:_
Address:
City:_
Zip: —
Phone:
Not Applicable
State:
Not Applicable
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 attorne before commencing work or recording our Notice of Commencement.
Signature of Owner essee/Contractor as Agent for Owner Signature of Contract r/License Holder
STATE OF FLORIDA
COUNTY OF Florida
STATE OF FLORIDA
COUNTY OF Florida
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 8 day of December 2020 by this S day of December , 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 /f
,6ignature of Notary Pu I.i 9 °T�Lft&' IISSION#GG932673 �gnature of Notar c1 c r rnuvor
EXPIRE January 21, 2024 f i tee ON # GG 932673
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Rev. 5/6/20