HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAil 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 A-
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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PROPOSED IMPRO`VE,MENT LOCATION:
Address:. . a} q...,.. M�1'f+0 Of
PrapertyTax ID #: ';"batD (� h ' l } ��� � ���' Lot No.
Site Plan Name: Block No. �1 g
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _- as Tank —Gas Piping Shutters —Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 5q. Ft. of First Floor:
Cost of Construction: $ l , q 43U Utilities: Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1
Address::]P�� QQIV�qz
Name: Bx nc.0 11
Company: t
Address:
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City: ,r�� State
Zip Code: Fax:
Phone No. >SC��
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
City:
Zip Code:
Phone No_2� 6i, 4
State:_
Fax:
4Oci
E-Mail
State or County License
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if 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.
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State: _
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER;
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 ppermit will authorize the permit holderte 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. Lucle 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-residentlal use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
Improvements to your prop ty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted oe jobsite before the first inspection, If you intend to obtain financing, consult
with lender or an attorn before commencing work or recording vour Notice of Commencement.
Signature
STATE OF FLORIQ 4
COUNTY OF�d ^? r t
as Agent for Owner
Sworn to (or affir ed) and subscribed before me ofPhysical Presence or Online Notarization
this day of 201 by
Personally Known 5`� OR Produced Identification
Type of Identification Produced
FVVh 16. � D_ i wry�� d
(Signature of Notary Public- Statep�
DANIELLGWNCALVES
Commission No, fRi �yf 3 MYcbMMI$SION#00232946
ivnP d ,k�"r Bondod TMuu Wow P blic NMemiler
REVIEWS COUNTER I EEVIEW S REVIEW R� PLANS REVIEW I VREVIEWON I SEREVIEWLE MR VIEWVE
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Proposal / Agreement
)oann Bolte
August 6, 2021
5209 Myrtle Drive
Fort Pierce, FL 34982
772-489-5525
jebcIte ,,ahotmaH.com
1) Supply and install (1) customer owned 500 gallon underground LP Tank with
gas line to generator and Final connect.
2) Price includes 40Ft of extended service.
3) Price includes backFiIli
ng
4) Obtaln all permits & inspections needed.
5) Price does NOT include filling the tank with propane, price per gallon will be
based off Thompson Gas' market prices.
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For the sa<trrt of: _� -4 5-• g" J•o�
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TERMS:
Charges & Payments: Charges are due ,n fail at time services are rendered unless otherwise stated below. Contractor may
harge and customer agrees to pay a late fee for aii past due payments, such fees not to exceed the maximum allowed rate by
applicable law. Customer shall be responsible and agrees to pay for all charges billed, applicable taxes, applicable legal fees and
other charges/fees, Customer shalt be responsible for any stop payment, charge backs or returned checks in the amourt of
$25.00 or 3% whichever is greater.
Grass will be replaced up to 100 square feet or any lawn damage that may be caused due to excavation. Will repair any mdi
sewer or sprinkler line damage due to excavation
Proposal/Contract pricing good for 30 days from Proposal/Contract date
! $1,995.00 due C Signing
$1,100.00 due @ Gas Tank Installation
$1,100.00 due @ Gas Line Connection
$300.00 due @ Final Inspection
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We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration,
Authorized signature:
John Maruri 772-626-4691
Acceptance of proposal
I jO At t j --j Q LTE _ _ (printed name), authorize Energized Gas to
complete the work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined above.
Date ?-11—,,) i
signatihe
This agreement shall be construed under the laws of the State of Florida. This agreement contains the ertire understanding of the
parties and supersedes all previous verbal or written agreements: there are no other agreements, representations or warranties not
set forth herein. If any conflicts exist in this agreement between terms which are printed and those which are typed or wntten, the
typed or wntten language shall govern.
Pace 2 of 3
CONTRACT TERMS AND CONDITIONS
Installation will comply with all focal and state regulations and be consistent with standard industry code.
This contract price does NOT include bondfng 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 REFUNI?ADLE 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
.J c, A, P. r t,T
PRINTED NAME
Z.- n
SIGNATURE
B-11,)1
DATE
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