HomeMy WebLinkAboutBUILDING PERMIT APP - 8-17-21All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
S J' At,
Jim
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:GAS
PROPOSED IMPROVEMENT LOCATION:
Address: 9640 Fairwood CT
Property Tax ID #: 3322-500-0007-000-2
Site Plan Name: RJM - DELACH
Project Name: RJM - DELACH
Permit Number:
Building Permit Application
Commercial Residential x
DETAILED DESCRIPTION OF WORK:
EXTERIOR LP GAS TANK AND LINES AND INTERIOR LP GAS LINES
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical ( Gas Tank �—as Piping _Shutters
_ Electric _ Plumbing _ Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 8580
Sq. Ft. of First Floor:
Lot No.3
Block No.
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameJoseph W Delach
Name: Cheyenne Ellison
Address:5725 Meyerfield CT
Company: PROPANE SERVICES INC. IDEA Elite Gas Contractors
City: Sykesville State: _
Zip Code: 21784 Fax: (772)220-1829
Phone No.(772)220-9678
Address:2130 Poma Drive
City,. Palm City State: FL
Zip Code: 34990 Fax: (772)220-1829
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-Mailemcintosh@elitegasco.com
State or County License 18361
��• �•• •�•� •� a..,......� ..... a ncwnucu notice or 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 con lict 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."
Signatur of Owner/ Lessee/Contractor as Agent for Owner
Signature Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF &k0-y4 v%,
COUNTY OF &&-G Ft 1ti
The forgoing instrument was acknowledged before me
this J3_ day of QUs+ • 20 Rl by
The forgoing instrument was acknowledged before me
this, day of 9U9+ • 20 _Q1 by
sv.�.0
C� Q LJe VA,ll FDQ ao_,
Gl Pam \ _ F14 QLA 1-8y
Name of pdson makingstatement.
Name of p rs n making statement.
Personally Known V OR Produced Identification
Personally Known �� OR Produced Identification
Type of Identification
Type of Identification
Prod ced
Produce
(Signature of No ary P
(Signatu of No PM
Notary Public State Of Flontla
Commission No.Desirel-5"clntosh
My Commission GG 283399
ql�wvExpires 12/112022
��e, Notary public State o1 Florida
Commission No. Desirek, ehiklntosh
a My Commission GG 283399
pp6 Expires 12/112022
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