HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
O
�:..�.._,__.. Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 C13DG Funding
PERMIT APPLICATION FOR: b-) �1\ -Y1,� IL
PROPOSED IMPROVEMENT LOCATION:
Address: ��1(.)� r�C� �� �_ � (,� (CA irk@)
Property Tax ID #: � -s()�' (0 (n sk a " )L> ,
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Lot N o.
Block No.gS
�� 1 \ t�Je Jai 1� 4 I_ b n ( P('/' i G A�{ � � � �� C
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical 'Gas Tank _ Gas Piping _ Shutters
(Affidavit required)
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ &1 b
Sq. Ft. of First Floor:
-Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: ki[no, C'4 �1.(A.)Cl,YLUi
Address: C.� �V
Company: C
Address: V
City: i�%0 Stater_
Zip Code: "WGIS1 Fax:
Phone No. I-A(4aL> E-
City: RrCC2 Stated
Zip Code; Fax:
Phone No. U,LP OqS
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License � &1",S42
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 conflicts with anY applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 owthe jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorrLK before commencing work or recording your Notice of Commencement.
Signature of r/ S, ssee/Contractor as Agent for Owner
STATE OF FLOf{FD/
COUNTY OF ) ,�
Swop to (or affirY d),and subscribed before me of Physical Presence or Online Notarization
thisday of f I\X fl/�
p�/20�Iby
!
6" t 2�1vy t,II'AA 9 N iA,Q
Name of person making statement.
Personally Known K_ OR Produced Identification
Ty e of Identification Prod{{uce �(��— a
��� _� \ a - fl Rfl ��..j _
(Signature of Notary Public- State of Florida)
Commission No. %Z Sea�J
DANIELLE GONCALVES
MYCOMMI9tiSION # GG 232ggg
EXPIRE$:June27,2022
aonded T6ru Notary
pu61'
r3" _
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ReV b/ZU/Z I
*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*
Proposal / Agreement
Charles Rowe
7901 Santa Clara Boulevard
Fort Pierce, FL 34951
202-294-4620
crowexvii@live.com
June 3, 2021
1) Supply and install (1) customer owned 1000 gallon underground LP Tank with
gas line to generator and final connect.
2) Price includes backfilling and removing dirt.
3) Obtain all permits & inspections needed.
4) Price does NOT include filling the tank with propane, price per gallon will be
based off Thompson Gas' market prices.
or the sumo : $5,050.00
TERMS:
Charges & Payments: Charges are due in full at time services are rendered unless otherwise stated below. Contractor may
charge and customer agrees to pay a late fee for all 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 shall be responsible for any stop payment, charge backs or returned checks in the amount of
$25.00 or 3% whichever is greater.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$1,995.00 due @ Signing
$1,377.50 due @ Gas Tank Installation
$1,377.50 due @ Gas Line Connection
$300.00 due @ Final Inspection
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your con ideration.
Authorized signature:
n Mar6ri 772-626-4691
Acceptance of Proposal
I, � s '� • L,.4 (printed name), authorize Energized Gas to
complete the work in accord I Inthe above specifications and conditions. I agree to pay as per
terms outlined above,
D a t e � � �04f
Signature
This agreement shall be construed under the laws of the State of Florida. This agreement contains the entire 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 written, the
typed or written language shall govern.
Page 2 of 3
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with standard industry code.
Installers are not responsible for landscaping repairs as a result of installation*. This includes but is not
limited to; damaged/broken sprinkler lines and/or damaged/broken water or sewer lines.
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
rV�
Customer is responsible for obtainin OA/POA approv 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
�'7 'og
D TE
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