HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i2021 Permit Number: /')`�I v ' vy311z
RECEIVED
Building Permit Application-
Planning and Development Services AUG 04 2021
Building and Code Regulation Division SL
2300 Virginia Avenue,Fort Pierce FL 34982 County
Permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X.
PERMITTYPE:GaS
PROPOSED IMPROVEMENT LOCATION:
Address: 2351 S Brocksmith RD
Property Tax ID#: 2320-501-0022-000-7 Lot No.
Site Plan Name: Block No.
Project Name: Rodriguez
DETAILED DESCRIPTION OF WORK:
1000 Gallon tank and line to a generator.
CONSTRUCTIOWINFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical X 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 Ernest Rodriguez Name:Cheyenne Ellison
Address:2351 S BROCKSMITH RD Company:Propane Services DBA Elite Gas Contractors
City: Ft. Pierce State:_ Address:2130 SW Poma Dr
Zip Code: 34945 Fax:772-220-1829 City: Palm City State:FL
Phone No.772-220-9678 Zip Code: 34990 Fax: 772-220-1829
E-Mail:jmelendez@elitegasco.com Phone No772-220-9678
Fill in fee simple Title Holder on next page(if different E-Maillmelendez@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 NOTICE OF COMMENCEMENT."
Signature of ner/Lessee/Contractor as Agent for Owner Signature of ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_NA o.✓-ti COUNTY OF VGA-0--%- I-i w
The forgoing instrument was acknowledged before me The forgoing instrumTt was acknowledged before me
this 3(�day of ALA,1_T=20al by this_Oday of JIJL\y 204A by
CC:r^
Name of pe making statement. Name of perso making st ement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
P duced Produce
— `7 --(Signa o a (Signature of ry
Notary Public State of Florida vtY w Notary Public State of Florida
Commission No. Desiree N Nksh Commission No. '4 �' Desiree N($�gldsh
Commis 283399 h - My Commission GG 283399
?aad►P Expires 12/11/2022
njpa ' Expires 12/11l2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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