HomeMy WebLinkAboutPERMIT APP - 2-4-21All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
'
COUNTY
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial Residential x
PERMIT TYPE: GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 1409 NW LANCEWOOD TER
Property Tax ID #: 4426-804-0029-000-7 Lot No.
Site Plan Name: RUOTOLO Block No.
Project Name: RUOTOLO
DETAILED DESCRIPTION OF WORK:
EXTERIOR LP GAS TANK AND LINES TO GENERATOR
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2300 Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ronald A Ruotolo
Name: Cheyenne Ellison
Address:1409 Lancewood TER
Company: Elite Gas Contractors
City: Palm City State: _
Address:2130 Poma Drive
City: Palm City State: FL
Zip Code: 34990 Fax:(772)220-1829
Phone No. (772)220-9678
Zip Code: 34990 Fax: (772)220-1829
E-Mail:emcintosh@elitegasco.com
Phone No(772)220-9678
Fill in fee simple Title Holder on next page (if different
E-Mailemcintosh@elitegasco.com
State or County License 18361
from the Owner listed above)
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 MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Name:_
Address:
Address:
City:
City:_
Zip: Phone:
Zip:
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:"
, ea,
Sgnatu ofl ner/ Lessee/Contractor as Agent for Owner
Sig,e
nature o ontractor/License kider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF A4e4re ft'n
COUNTY OF /Lf a
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The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisday of k ' , 20 .21 by
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this � day of ,(�j_
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a✓0 / 4=Q et ,
Name d4eirson making statement.
Name of rson making s atement.
Personally Known V OR Produced Identification
Personally Known
OR Produced Identification
Type of Identification
Type of Identification
W-cidluced
Pro ced
(Signatur of
(Signature o
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Notary Public State of Florida
Commission No. Z �: Desiree N MgIPtoSh
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Notary Public State of Floritla
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Expires 12111/2022
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