HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: 7/13/2021 Permit Numbe
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
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Address: 2738 BROCKSMITH-RD
Property Tait ID #: 2320-501-0053-000-3 Lot No.
Site Plan Name: Burgess Block No.
Project Name: Burgess
►' ! � ► ► h-`CRt PTIO OF WO � .
500 gallon tank and line to a portable,generator.
Additional work to be performed under this permit —check all that apply:
_Mechanical )( Gas Tank _X Gas Piping _ Shutters _ Windows/Doors
Electric ' _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 2400.00
Generator _ Roof
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Pitch
OWNER 'SSEE:
CONTRACTOR:
NameJoshua Michael Burgess
Name: Cheyenne Ellison
Address:2738 BROCKSMITH RD
Company: Propane Services DBA Elite Gas Contractors
Address:2130 SW Poma Dr
City: Fort Pierce State: L
Zip Code: 34945 Fax:772-220-1829
Phone No. 772-220-9678
City: Palm City State: FL
Zip Code: 34990 Fax: 772-220-1829
Phone No772-220-9678
E-Mail:jmelendez@elitegasco.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Maillmelendez@elitegasco.com
State or County License 18361
It value of construction is S2500 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.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:yY^' _ 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 o wner/ Lessee/Contractor as Agent for Owner
Signature of tractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF_L,L�a42_
COUNTY OF
The f41oing instru e t was acknowledged before me
this► I J day of 2Q�A by
The fo�oing instru ent was acknowledged before me
this k�_) day of 208L, by
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e M SL FAk a .7.)n
Name of person making statement.
Name of person making statement.
Personally Known )C OR Produced Identification
Personally Known �_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary blic=
ature of Notary P blic- S
�"A'P i� BRITTANY RED
B`�= f Florida -Notary
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BRITTANY REDD
° °`�� of Florida Notary
��o�missian # GG 1 90
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REVIEWS
FRONT
PLANS
VEGETATION
ZONING
SUPERVISOR
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev.2/7/19
dic
2