HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMP RI)D FOR APPLICATION TO BE ACCEPTED
Date. 7-8-2021 Permit Number: Ito')
e o -
RECEIVED
Building Permit Application JUL 12 2021
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982
St. Lucie County
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT TYPE:Propane Gas
PROPOSED IMPROVEMENT LOCATION:
Address: 12035 S Indian River Dr
Property Tax ID#: 4504-601-0030-000-3 Lot No:
Site Plan Name: Diana Ewing Top of Walto S/D lots 30 and 31 with RIP RTS Block No.
Project Name: Gas Tank
DETAILED DESCRIPTION OF WORK:
Gas tank and line to stove 'Ty i.S /s Fog m&I n! /-tdosi 0 ne wesIr
1DrZ D F -rN6 Roque Sign
Here)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _XGas Piping _Shutters 0 Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2200.00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Diana Ewing Name:cheyenne ellison
Address:12035 S Indian River Dr Company:elite gas/Propane services inc
City: Jensen beach State: FL Address:2130 SW Poma Dr
Zip Code: 34957 Fax: City: Pakm City State:FI
Phone No.786-999-2298 Zip.Code: 34990 Fax:
E-Mail:gsolana@live.com Phone No772-341-4808
Fill in fee simple Title Holder on next page (if different E-MailThoskins@elitegasco.com
from the Owner listed above) State or County License 18361
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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 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 YOUR NOTICE OF COMMENCEMENT."
Signature of Ow essee C to ontractor as Agent for Owner Signa re of Contracr/License Holder
STATE OF ORIDA STATE OF FLORIDA
COUNTY OF ��s" �- COUNTY OF /L4
The for oing instrument as cknowledged before me The for oing instrument was acknowledged before me
this day of V u 20 a/by this day of U to 20 al by
Name of person making tatement. Name of person making atement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced, Produced
(Signature o Notary (Signature of No ary�Pb i - t t f l r't{otary Public State of FloridaCommission No. Desireer��¢intOsh c`�rt 0 teryPubligStatq hFlorida
My Com issio GG 283399 Commission No. esiree N I����ibb
?a w Expires 12/1112022 My Commission GG 283399
?a¢ ' Expires 12/1112022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19