HomeMy WebLinkAboutgas app, contractAll 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 CBDG Funding
PERMIT APPLICATION FOR: oc+u-�1(
PROPOSED IMPROVEMENT LOCATION: J/
Address: �L� ! W1�
Property Tax ID #: N.
` Lot No.
Site Plan Name: �i BlockNo. Y6
Project Name: ftffff CA
'_J
DETAILED DESCRIPTION OF WORK:
f
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical was Tank —Gas Piping _ Shutters Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers ` Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
C"'�6b
Cost of Construction: $ Cc OD Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1
Name: I
Addre i�i6Li vmcA
Company:
City: Stater
Zip Code: Fax:
Phone NoE-
Address: fir--
t�
City: aStates,_
k ti
Zip Code: "tQ�� ( Fax:
Phone No__1rI � q(
E-Mail Ifrom
State or County License l
Mail:
Fill in fee simple Title Holder on next page (if different
the Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
tate:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made toobtain 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 anly applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t 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 poster,Lon the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an atto v before commencine work or recording vnur Notirp of C'nmmPnrPmPnr
Signature of Conte/It
on t r - or - Owner Builder as applicable
STATE OF FLORI
COUNTY OF
Sworn to (or affirmed)and subscribed before me of Physical Presence or Online Notarization
this �'" day of 200L-by
MO
l(
Name of person making statement.
`x OR Produced Identification
Personally Known
Type of Identification Produced
— (')� L �-_ J�-Jy_ r I J '4
(Signature of Notary Public- State of Florida)
Commission No. flANIELLEGOt4CALVES i
*• :*: N§Y CbMMISSION V GG 232946
�-' , EXPiRES: Junf
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
I\4v 1V� 1Gf G1
ft =40
4757 T ajwly Blvd. Fart. Pwi( v, f I 04 )R1 Tto,i%mc t („w.1
72S Comn)er(e CLI. Dr. Site. 1 `;t,h,)!,ll.rn, I I 09'd, '-i o'.1'.if,
2-158 Old Okeechobee MvO Ste c) We-d I',slrl, It, .,€ ii, 1 1 ; .401i I"Iln
PROPOSAL / CLIENT AGREEMENT
Customer(s)Name: &OW¢.rr.A
Address:
City: P_S �- ST--�i=__ tip�3
S�O i Wo -7 ` 4-1 G 4
Home: w►
Ceti: _-0
!i Sq (�rctnn
Emali:}r✓C4iJ_�
Additional Info:
Generator / Electric Proposal: Kohler kw / model #
Generac # 12kw lBkw 22kw 24kw # of L/S:-2.
# Transfer Switch(s): # of Main(s) Main Breaker Size
!��' i
Warrantee Term: t O yrs. Electric Dist. Total u�� -__ Extended .�
Cxcs (SfVCLeV-")i 4-b
Including: Delivery, Set up, Preformed Concr to Pad, Wifi Monitoring Device,
Labor, Battery (1 yr. warn.), Materials & All Permits Required by Town or County
('�7(_ CZ-) 41 c WIC-� • 1 S �� J t �'Lc.1
Propane or Gas Quote
JL New Propane Tank (size): 250ga1. 500gal. 1000gal. Other:
Existing Natural Gas / Propane Connection Required: Yes
Fuel Line Distance: Total __L�J,.__,- ft. Extended Service ft.
AG: UG: 1/ Strapped Stub Out: Yes No
Additional Info:
Additional Products and Services:
Whole House Surge Protector_ Sub Panel Range Ext. 4G LTE
Other:
Payment Terms:
Total Deposit Due on Signing Agreement $ �I
Total Due Upon Released of Permits $
Total Due Upon Electric & Gas Installed $
Total Due Upon Generator Delivered $ .._
Total Due After Final Inspection & Start Up $ - 6 -- T
561e• Rap:
Joe
Day / Date Time
T -k I EVA 14
Yes tin
HaluraLGaaLEx!!tl n931 an an a:
YC5 , Flo
5[zw of HausE;
total
Generatorquote:
Gen. + Install: $ Z
Discount / Coupon: $
Quote Amount: $1 Z , 438
Propane / Gas Quote
Gas / Propane Install
& Connections: $
Discount / Coupon: $
Quote Amount: $ C>
Total Quote: Gas & Electric
This price is valid for 30 days
rRe osit Amount per Service:
Generator. $
Gas/Propane: $ _
Follow Up Dates:
ACCEPIANCE DE PROPOSAL
I Empowered Solutions (printed name), authorize Energized Electric to complete the
work In accordance with the above specifications and conditions. I agree to pay as per terms outlined above and to
addi�trm back.
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Sigrfaffe-
Date
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