HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
' c�51019
Building Permit Application Nod:
Planning and Development Services ltt�ri9 Dep ty
Building and Code Regulation Division pe S . �uAe Co
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPEIP tank
PROPOSEDIMPROVEMENI-LOCATION YQ.
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Address: 11001 S Indian River DR Fort Pierce, FL 34982
Property Tax ID #: 3532-503-0030-0006
Site Plan Name: Polhemus
Project Name:
Lot No.2/3
Block No. 3
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DETAILED DESCRIPTION OF WQRK� ,
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Supply and install 120 gallon tank with gas line to (1) range and (2) tankless water heaters and final connect
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CONSTRUCTION INFORMATIOxs
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Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric
Total Sq. Ft of Construction:
.Plumbing _ Sprinklers
Cost of Construction: $ 6400.00
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
tOV1/NER%LESSEE �' r `� � °
.`CONTRACTOR '� '
NameTheresa Polhemus
Name: Blake Cowdell
Address:11001 S Indian River DR
Company: Energized Gas
City: Fort Pierce State:'
Zip Code: 34982 Fax:
Phone No.
Address:1786 SW Biltmore St
City: Port ST Lucie State: FL
Zip Code: 34984 Fax: 7723186672
Phone No7724661095
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail energizedgenerators@gmail.com
State or County License LG34747
If value of construction is $2500 or more, a RECORDED 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: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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 of Owner/ Lessee/'C'ontractor as Agent for Owner
STATE OF FLO
COUNTY OF
The forgoing instrAment was acknowledged before me
this Unday ofUffM IDW 20& by
,�(ak no')C�P (i
Name of person making statement.
Personally Known ')\'— OR Produced Identification
Type of Identification
l
(Signature of Not of FI ida )
pAN1E1]F GIN rFAo n NM�.�.,, aMtSS1�N #�2GG 232946ISeal)
Stine
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Signature of Contractor/License Holder
STATE OF FLCQA' A ,l
COUNTY OF
The for rigging ins r ment wa ckno edgka d before me
this day of 20 by
f-AC&
�l
Nam—eof person making statement.
Personally Known X OR Produced Identification
Type of Identification
Produced
s "" 2329,46
(Signature o a �itjlipy$��#t
EXPIRES: June 27;,2022
Commission riNOt3ryPuwu der'
'•vrFOF��o,•' BOn
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19