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All APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO 13E ACCEPTED
Date: Permit Number:
SPOONS 1w4i",
Building i 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 CBDG Funding
PERMIT APPLICATION FOR:(�� n Y
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PropertyTaxlD#: E A
Site Plan Name:
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Address' Company:
City: + State: Address: i
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Phone No E Zip Code:
Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail ; C �7
from the Owner listed above) State or County Licer
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAUC is'$7,500 or more, a RECORDED Notice of Commencement is required.
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State:°
_ Fax:
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: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
vvv1VF_n/ %-vim 1 RHI, t vK F1rriuvi I :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 on thejepsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney bP rnmmanrina \e,nrlr nr ror^rr;i , ..r ni.+o s
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Signature of Owner/ ssee/ ntractor as Agent for Owner
STATE OF FLORIDA
COUNTY OFF
Sworn to (or affir d and subscribed before me of Physical Presence or Online Notarization
this 'dayof�•--i C 20, 1 by
Name of person making statement.
Personally Known '`,f OR Produced Identification
e of Identification Produce
k° i(LL A-IM-P I AP
(Signature of Notary Public- tate of Florida)
Commission No. ! Y; Seal) DANIELLEGONCALVES
COMPhISSION # GG 232946
EXPIRiS:.lune 27, 2022
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F. Vic.. ;.;•UC.,, Ia f
F3onc..n ] Thru P•tot�ry Public Under��rLers -
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
PV
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I E
- LL LED Q: EM-7- H
*Trc*isurc Coast '772-466-1095, 4.252 Bandy Blvd, Fort Pierce, FL, 3 )4.98 1, Fax 772-3 18-6072*
*Paljll Bcacl-i 561-752-0214, 2758 Old Okeechobee Bk'd, Suite 9, West Palm Beach, FL, 33409*
"Sebastian 772-778-013 L 725 Co*nnmerce Center Drive Suite. ,1, Sebastian, FL 32958"
*Energized Electric Gas Department 772-241-1-5279.4258 Bandy Blvd, Fort Pierce, FL, 34981*
Proposal / Agreement
Elite Electric & Air
(Clay Cook)
5310 Deer Run Drive
Fort Pierce, FL 34951
(772) 340-3797
rachelm@eliteelectricandair.com
September 7, 2021
1) Supply and install (1) customer owned 250 gallon underground LP Tank with
gas line to generator and final connect.
2) Price includes 5ft of extended service.
3) Obtain all permits & inspections needed.
4) Price includes backfilling and removing dirt.
5) Price does NOT include filling the tank with
based off Thompson Gas' market prices.
propane, price per gallon will be
For the sunt Qf: _ $3495-070
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.
Grass will be replaced up to 100 square feet or any lawn damage that may be caused due to excavation. Will repair any minor
sewer or sprinkler line damage due to excavation.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$1,995.00 due @ Signing
00-00 due @ Gas Tank Installation
00.00 glue @ Gas Line Connection
$300.00 glue @ 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 consideration.
Authorized signature:
Seth Willmot
Acceptance of Proposal
(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.
Signature
Date `- r
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.
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CONTRACT TERMS AND CONDITIONS
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
Y- I o
PRINTED NAME
9
DA E
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