HomeMy WebLinkAboutPERMIT APP - 3-30-21All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3/29/21 Permit Number:
•
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:GAS
L rr U.btu IMPRUVEMENT LOCATION:
Address: 2951 S BROCKSMITH RD
Property Tax ID #: 2320-501-0047-000-8
Site Plan Name: Santana
Project Name: Santana
Building Permit Application
Commercial Residential x
DETAILED DESCRIPTION OF WORK:
EXTERIOR LP GAS TANK AND LINES AND INTERIOR LP GAS LINES
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 4500
Generator
Sq. Ft. of First Floor:
Lot No.16
Block No. 3
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameJonathan Santana
Name:Cheyenne Ellison
Address:1626 Hawthorne PL
Company:Elite Gas Contractors
City: Wellington State: _
Zip Code:33414 Fax:(772)220-1829
Phone No.(772)220-9678
Address:2130 Perna 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-Mail emcintosh@elitegasco.com
State or County License 18361
--•-- -•--••-••- •.5, • _, a n«GRDED nonce or Lommencement 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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
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 bylaws
rules, 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 INS TION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORD YOUR NOTICE OF COMMENCEMENT."
Signature of Owner a/Contractor as Agent for Owner
Signature of Contracto a Holder
STATE OF FLORIDA
COUNTY OF AA_2t,r-fiv_
STATE OF FLORIDA
COUNTY OF A .at_.-h r^-
The fo,r,ggoping instrument was acknowledged before me
this c(7day of IM 0.rC4. 20 oi( by
The forgoing instrument was acknowledged before me
this D72day of , 20,:24 by
m—
c-� ey_�
Name of pefson making s tement.
Name of pe n makings tement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Pro ced
(Signature of N
yY� Notary Public fate of Florida
Commission No. Desiree N Malatstsh
y ommisst 283399
Ojaw Expires 12/11/2022
�pA Notary Public State of Florida
Desiree N M�A
Commission No. 2
Commisv 83399
jaw Expires 12/112022
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