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HomeMy WebLinkAboutREVISION FORMOFFICE USE ONLY: DATE FILED: REVISION FEE: PERMIT # RECEIPT T # PLANNING & DEVELOPMENT SERVICES BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FL 34982.5652 (772) 462-1553 APPLICATION FOR BUILDING PERM IT REVISIONS PROJECT INFORMATION LOCATION/SITE ADDRESS:,-) �, � D t Wbt D V't - 1,i A 0,1 . DETAILED DESCRIPTION OF PROJECT REVISIONS: I CONTRACTOR INFORMATION: G G STATE of FL REG./CE T. #: '� �� ST. LUCIE CO CERT. #: p S7—) BUSINESS NAME: - QUALIFIERS NAME: ADDRESS: �01 U✓1 CITY: '\/ STATE: PHONE (DAYTIME): - C1 L- FAX OWNER/BUILDER INFORMATION: NAME: M v A S 4- ADDRES '- CITY: STATE: PHONE (DAYTIME: l — FAX: ARCHITECT/ENGINEER INFORMATION: NAME: ADDRESS: CITY: STATE: PHONE (DAYTIME): FAX: SLCCC: W23/09 Revised 06/3011 ? ZIP: r � J ,A,d� 6P' ppK1iE R'orir [.� gy1Y io�'o C H R IST'OPH ER E N LUXURY HOMES PURCHASE ORDER Christopher Burton Luxury Homes PO: 2114146 6013 Farcenda Place Suite 101 PO Date: 05/11/2021 Melbourne, FL 32940 Job No: 1905 (321) 757-3247 Permit No: CM: Steven Chilberg Phase No: 82 Vendor No: 8201 TO — — — — — SHIP TO Name: AmeriGas Propane Name: Yolanda & Sandy Mack Address: 4190 S US #1 ModellElev: Custom Plan / A Rockledge, FL 32955 Site Legal: Lot 11 Saba] Creek Phase 1 OYL Phone No: 321-631-5070 Address: 7840 Saddlebrook Drive Fax No; Port St Lucie, FL 34986 Item No Description UOM Tax Quantity Unit Cost Extended Add 2nd 1000 gallon tank and manifold EACH N 1 $5,477.00 $5,477,00 Sub Total ; $5,477.00 Sales Tax : $0.00 Tota 1 ; $5.477.00 Warning: General Liability and/or Workman's Compensation and/or Automobile Insurance expiration: General Liability: 10/27/12 Workman's Comp: 10/27/12 Automobile: 10/27/12 Purchase Order will be null and void unless current Certificate of insurance is received prior to start of work. Notes: SUBCONTRACTORS MUST COMPLY WITH ALL OSHA SAFETY REGULATIONS, INCLUDING FALL PROTECTION SAFETY STANDARD 29 CFR 1926.60(b)(13). Christopher Burton Luxury Homes 06/11/2021 03:49 P.M. Page 1 of 1