HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.
Permit Number:
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° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft_ 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: - f _�,,
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: Lot No. ._]
Site Plan Name: Block No.
Project Name: &r �i1n
DETAILED DESCRIPTION OF WORK:
0 U d S b C-Ar-Alion
5
New Electrical Meter Second Electrical Meter (Affidavit required)
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical S Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
u�
Cost of Construction: $ -AS Utilities: — Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1 vj t o
Name: �-kLUYI " t t1
Company: V iL
Address: 1
Address:jq�l CCY1d-cc oii'-
City: tLprFu State-T�
Zip Code: AAY Fax:
Phone No. UJ I -�� - S `k� ,?
City: P �j�[- _ Stater
Zip Code: Fax:
Phone No (Q
E-Mail
State or County License'I,L'l12 d2
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above]
It value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted an th jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney ore commencing work or recording our Notice of Commencement.
Signature of caner/ Lessee/Contractor as Agent for Owner
STATE OF FLOR A
COUNTY OF �-i
Sworn to (or affirm d) and subscribed before me of Physical Presence or online Notarization
this aday ofm1A 20 a\ by
Name of person making statement.
Personally Known/CDR Produced Identification
Type of Identification Produced
Ij\
AAY
(Signature of Notary Public- State of Florida )
,•r;wYPy.. DANIELiEGONCALVES
Commission No. (Seal) °„ MY COMMISSION#GG232946
=_a• o;' EXPIRES: June 27, 2022
Bonded Thru Notary Pu4lic UncJ .rr;nters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5120121
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*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 2758 Old Okeechobee Blvd, Suite 9, West Palm Beach, FL, 33409*
"Sebastian 772-778-0131, 725 Commerce Center Drive Suite J, Sebastian, FL 32958*
*1 neruized Electric Gas Department 772-241-5279, 4258 Bandy Blvd, Fort Pierce, FL., 34981*
Proposal / Agreement
Thomas Bieselia P
24j91 Conifer Drive
Fort Pierce, FL 34951
631-943-1468
Tbees2@gmail.com
August 9, 2021
1) Supply and install (1) customer owned 250 gallon underground LP Tank with
gas line to generator and final connect.
2) Obtain all permits & inspections needed.
3) Price includes backfilling and removing dirt.
4) Price does NOT include filling the tank with propane, price per gallon will be
based off Thompson Gas' market prices.
or the sum o -: $3929�,0
Installation will comply with all local and state regulations and be consistent with standard industry code.
This contract price does NOT include bonding gas lines, converting outlets, converting appliances or
carbon monoxide detectors.
Additional charges may apply if rock and/or roots are encountered during the excavation process.
Deposit will be forfeited if customer cancels after the permit process is initiated.
Customer is responsible for obtaining HOA/POA approval. Installer is not responsible for customers failing
to obtain final approval.
If home is located in flood zone, the additional cost will be the responsibility of the homeowner if a tank tie
down, or buoyancy pad is required per the building department.
A site survey of your property showing all property lines is required to pull a permit and can be submitted
along with this signed proposal.
$395.00 of the initial deposit is NON REFUNDABLE if customer cancels after signing this contract
or makes a deposit for any reason. No refunds will be given at all after permits have been
applied for or installation begins.
*To include sod replacement a charge of $395 applies.
CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE TERMS
PRINTED NAME
SIGNATURE
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P�WT
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