HomeMy WebLinkAboutPERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `� _ Permit NumberMIL
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:CO
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
rtrclvtl I I YPL:GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 2014 NW ROYAL FERN CT
Property Tax ID a: 4425-605-0021-000-7
Site Plan Name: KELLETT
Project Name: KELLETT
DETAILED DESCRIPTION OF WORK:
EXTERIOR LP GAS TANK AND LINES GENERATOR
Lot No.
Block No.
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
_Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 2300
X Gas Piping _ Shutters
Sprinklers Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameLael G Kellett
Name:Cheyenne Ellison
Address:2014 NW Royal Fern Ct
Company: Elite Gas Contractors
City: Palm City State: _
Zip Code:34990 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
•• •-•-- -• --••�• •m•- - r-- a ncwnucu nonce or 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:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 NOTICEAF COMMENCEMENT."
9iC A&
c
Signatur f Owner/ Lessee/Contractor as Agent for Owner
Signature Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF kA&_r ; n
COUNTY OF MAy-ii r1
The forgoing instrument was acknowledged before me
The f r oing instr ment was acknowledged before me
this day of 20 &1 by
this day of 1UC1rt I . 20aj by
Glti.¢.taP�►'�th2_���ISOY�.
�¢�,tp�VIIrLQ EIIISOvL
Name of son making statement.
Name of peLjn makin tatement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
oducced
1
oduced
(Signature f Nqkrry
(SIgndLUle of 1 $16,t2rf Public- a of r d
gwzl °{mar Notary Public State of Florida
Commission N0. 1 . Gesiree t loSh
('
,y11 Notary Pub6y taa�LhFlorida
Commission No. � 4'
N
dy Comm S.GG 283399
l>ownd.P Ezprtes 12I11/2022
esiree
My Commission GG 283399
�` . e Expire s 12111)2022
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