HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7/14i21 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
YCKIVII 1 I yF't:GAS
f•KUFUbtIJ IMINKUVEMENT LOCATION:
Address: 2825 S BROCKSMITH RD
Property Tax ID #: 2320-501-0046-000-1
Site Plan Name: GROZA - WELLS
Project Name: GROZA -WELLS
DETAILED DESCRIPTION OF WORK:
INTERIOR LP LINE TO FUTURE APPLIANCES
Building Permit Application
Commercial Residential x
Lot No.
Block No.
CONSTRUCTION INFORMATION: I
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: $ 1500
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Carlos Lee Wells
Name: Cheyenne Ellison
Address:3821 SW Coquina Cove WAY Apt 106
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
34990 772 22 Zip Code: Fax: ( ) 0-1829
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
-- ----- ---••-••- •-•• •� I m, a =. wnucu nonce or Lommencement is requires.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
--"•'-n/ _Not Applicable MORTGAGE COMPANY:
Name: Not Applicable
Address: Name:
City: Address:
State: City -
Phone ZIP: . State:
ZIP: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Name: — Not Applicable
Address: Name:
City: Address:
Zip: Phone: City:
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.
which is inpconflircnt makes no
any applicable lHom Owners AssoclaLeionl runes abylaws or and covenants that build
ay 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 LF,NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF rnmmipwrcurwr n
as Agent for Owner
STATE OF FLORIDA
COUNTY OF_
The fo�rP,oing instru�ent`wa acknowledgedbefore me
this ping
of—`)�'yL.l ZOp by
2Y1(�P"ii--` ",
Name of person maKing statement.
Personally Known_ OR Produced Identification
Type of Identification
Produced
(Signature of NotaryY lF^ ,7te ofglRt�R,NY R
�` ate of Florida -Notary Public
o.
Commission N- omrryy��������ppn IfGG 190282
My CiSifilMission Expires
February 26. 2022
Signature of
STATE OF FLORIDA p
COUNTY OF_
The fo'`r�oing instru ent wa acknowledged pefore me
this � day of , 20 `Qi 1 by
Name of person riliaking statement. —
Personally Known % OR Produced Identification
Type of Identification
re of Notary
Commission No.
BRITTANY REDDIN
ate,pf FJ�rida-Notary Pub
o ion#GG 19028:
My Commission Expires
REVIEWS I FRONT I ZONING I SUPERVISOR I PLANS I VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW
glt I REVIEW REVIEW