HomeMy WebLinkAboutPERMIT APP - 2-24-21All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/24/21 Permit Number:
COUNTYIIIIIIII
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT TYPE: GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 3062 NW Radcliffe WAY
Property Tax ID #: 4425-703-0022-000-5 Lot No.17
Site Plan Name: LADD Block No.
Project Name: LADD
DETAILED DESCRIPTION OF WORK:
EXTERIOR LP GAS TANK AND LINES AND INTERIOR LP GAS LINES
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:.
Cost of Construction: $ 2400
Sq, Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Michael A Ladd Sr
Name:Cheyenne Ellison
Address:3062 NW Radcliffe WAY
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
n vame or cons[rucuon is aw ur niu-, a ---
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 YOLM NOTICE OF COMMENCEMENT."
Signature f Owner/ Lessee/Contractor as Agent for Owner
Signature of ntractor/License Holder
STATE OF FLORIDA
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STATE OF FLOR D� A
COUNTY OF l�Y
COUNTY OF
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The f rgoing instru nt was acknowledged before me
The f r ing instr nt was acknowledged efore me
this p [ day of 20_41 by
thisO day of by
Name of roedon making s atement.
Name of per makings tement.
Personally Known V� OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pro uced
Pr duced
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(Signature of a
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ZONING
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COMPLETED
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