HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPT
Date: 04-08-2021 Permit Number:
- - RECEIVED
Building Permit Application AUG 0 4 2021
Planning and Development Services 5t,6uola county
Building and Code Regulation Division Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT TYPE:propane Gas
PROPOSED IMPROVEMENT LOCATION:
Address: 9410 Carlton Rd Fort Pierce FI 34987
Property Tax ID#: 4203-221-0001-000-1 Lot No.
Site Plan Name: John Lessin Block No.
Project Name: John Lessin
DETAILED DESCRIPTION OF WORK:
Install a 500 gallon underground propane tank. Run 40 foot service line to home. Run new interior line to gas range
CONSTRUCTION INFORMATION:
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: Sq. Ft. of First Floor:
Cost of Construction: $ $2400.00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name John lessin Name:Cheyenne Ellison
Address:9410 cralton Rd Company:Elite gas contractors/ Propane Services
City: Fort Pierce State: ri- Address:2130 sw Poma Dr
Zip Code: 34987 Fax: City: Palm City State:FL
Phone No.561-801-6329 Zip Code: 34990 Fax:
E-Mail:john.lessin@fpl.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 CONSTRUCTION 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 NOTXEOF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � 7��- COUNTY OF
The for oing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day of 20� by this V day of 200?1 by
OP-0 tn—
Name of p&son making
/statement. Name of p on mak`ing�tatement.
Personally Known V OR Produced Identification Personally Known v OR Produced Identification
Type of Identification Type of Identification
Produce Produced
(Sign ure of N ar 'c-S a o i ) (Signature o Notary P - F
'W P& Notary Public State of Florida n P& Notary Public State of Florida
Commission No. _° NI D siree N dsh Commission No. r° Desiree�S It}�sh
y c Y My Commission GG 283399 y c z My Commission GG 283399
�� Expires 12/11/2022 r Expires 12/11/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 217119
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