HomeMy WebLinkAboutgas app, contractAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
llo L�l�.l�ULS •'1-
i Building Permit Application
Planning and Development Services
Commercial Residential
Building and Code Regulation Division
_
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
tr�eC
PROPOSED IMPROVEMENT LOCATION:
Address: ��� �'���-Q � �\�
Lot No.
Property Tax ID #:�
Site Plan Name:i Block No.
Project Name:vi�n;�5
f DETAILED DESCRIPTION OF WORK:. J
New Electrical Meter
Second Electrical Meter
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters
(Affidavit required)
Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ Utilities: —Sewer _Septic
Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name `
Name: ji I Jhbil
9uMYa n
Address: ' ( t `IC 6' _
City:State: '
Zip Code: 31�4ci.� i Fax:
Phone No.�' —0� E-
Company: E1
Address: }
r1acA
n�
City: �' " 1 � n
Zip Code:
Phone No
J State
Fax:
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ,
ft-Abfi QG L&i
State or County License,
IIIf value of construction is 2500 or more, a RECORDED Notice of Commencement is required. II
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:
Zip: Phone
City: State:
Zip; Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
C WNFR/ rr1NTRAr-rnQ ACEIr%xim .
,,,, , „NN„LdL,un is nereoy mace 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 the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an Zttornev ILp.,fnrP rnmmanrina XA,,,ri, — -4;-- ,—... "I_6:__
vi wrnmencement.
Signature of Owner/ Less a/Contractor as Agent for Owner
STATE OF FLORIP.A,,
COUNTY OF�(,�
(or affirmed) and subscribed before me of
Sworn today of ()/'QE4_ 20 � by
this Physical Presence or Online Notarization
y �� i,
Name of person making statement.
Personally Known OR Produced Identification
T e of Identification Produced
(Signature of Notary Public- Sta of Florida)
V;p, L)ANlELI_E G):i ICAI VET
Commission No. (Seal) ;<<•'``•':=,
rTr. MY CJMMISSM it GO. 232940 •
EX" !RES hire 27, 2022
}pa;! Bonded fhru Notary ry NA.. Urc..:��.�I.er li
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
*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*
*Energized Electric Gas Department 772-241-5279, 4258 Bandy Blvd, Fort Pierce, FL, 34981
Kelly Woodhouse
5612 Eagle Drive
Fort Pierce, FL 34951
(772) 971-2286
kert vsue woo Ca) yahoo. com
Proposal / Agreement
October 15, 2021
1) Supply and install (1) customer owned 500-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 sum 0 : $4�795•0
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
$1,250.00 due @ Gas Tank Installation
$1,250.00 due @ Gas Line Connection
$300 00 due @ Gas 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;
John Mauri 772-626-4691
Acceptance of Proposal
complete the work in accordance with the above specifi ap ons and name), authorize
I agree to pad Gs per
terms outlined above. Y p
Date j2j�j
�;L-
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.