HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: GAS
PROPOSED IMPROVEMENT LOCATION:
: 5405 DEER RUN DR
Address
Property Tax ID #: 1313-502-0038-000-0
Site Plan Name:
Project Name: JOHN CHALOUX
DETAILED DESCRIPTION OF WORK:
INSTALL NEW 50OG UG LP TANK
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Residential YES
Lot No. 461
Block No.
Additional work to be performed under this permit— check all that apply:
Mechanical _XGasTank XGas Piping _Shutters _Windows/Doors Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Hoof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 4,428.60
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name JOHN CHALOUX
Name: RONNIE KELLAR
Address: 5405 DEER RUN DRIVE
Company: EXCEL ELECTRIC LLC
City. FT PIERCE State:
Zip Code: 39451 Fax:
Phone No. 772-577-6794
Address: 1391 SW BELLEVUE AVE
City: PORT ST LUCIE State: FL
Zip Code: 34953 Fax:
Phone No 772-529-1091
E-Mail: JCSCJC@COMCAST. NET
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail EXCELOFFICE77@0MAIL.COM
State or County License Ll 45010
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNERIENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:_
Address:
City:
Zi p:
Phone:
Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name:
State
— Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicatea.
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 paying twice for
improvements to your property: A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. if you intend to obtain financing, consult
with lender or an attorney before commencing work or reqord'ing your Notice of Commencement.
srg'nature of Owner/ Lessee/Contractor as Agent for Owner Si nature of Contractor/ lcense Holder
STATE OF FLORIDA
COUNTY OF ST LUCIE
Sworn to (or affirmed) and subscribed before me of
✓ Physical Pres nce or Online Notarization
this cb- day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification x
Type of Identification
Produced uL
STATE OF FLORIDA
COUNTY OF STLUCIE
Sworn to (or affirmed) and subscribed before me of
`Physical Presence or Online Notarization
this jF
jn2 day of Sri) 202(' by
RONNIE KELLAR
Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
(Signature of Notary Public- State of Flor da }Wcmission
ure of Notad Public- State
* Notary Public State of Flo
Commission No. N ry Public S3� ;� a hley Simlamany
" � 3 t S ley Simlaission o.�f Commission GG 9463
My CommissioiqExpires 02i1612U24
d'Expires 021161REVIEWS FRONT ZONING SUPES VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVREVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED