HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L=, If E D
Building Permit Application NOV '0 7 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, clickarrow at the end of line
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Address: 3050 NW Radcliffe Way
Legal Description: Riverbend-(PB 67-36) Lot 14
Property Tax ID #: 4425-703-0019-000-1 Lot No.
Site Plan Name: Prasad Block No.
Project Name: Prasad
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to e e orme un er t is permit— c ec a apply:
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CJHVAC Gas Tank W]Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ 950.00 Utilities: Sewer Septic Building Height:
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Name Sanjay Prasad
Name: Cheyenne Ellison
Address: 3050 NW Radcliffe Way
Company: Propane Services Inc dba Elite Gas
City: Palm City State: FL
Address: 2130 SW Poma Dr
Zip Code: 34990 Fax:
City: Palm City State: FL
Phone No.
Zip Code: 34990 Fax:
E-Mail:
Phone No. 772-220-9678
Fill in fee simple Title Holder on next page (lif different
E-Mail: Kgehrke@elitegasco.com
from the Owner listed above)
State or County License: 18361
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:.
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 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. 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co mencine work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOT A
STATE OF FLORI A ,
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of }" 2052 by
this _L7._ day of O CA 20-0 by
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Nam f person making statement
Name of making statement
person
Personally Known ✓ OR Produced Identification
Personally Know OR Produced Identification
Type"�►�ti 'eation
Type of Identif' ation
odr` uced
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(Si7aluroPublic- Stateof Florida)
No ry Public- State of Florida'
Co,.•'i'PY®'''•, JANETSA �I
=.:Im .'a • commission # FF 207927
Com ission N .••'���° JANETSAI�OW (Seal)
�d : ;' o ission # FF 207927
g Expires March 10, 2019 ,'
? ` Expires March 10, 2019
E.51� ` Bonded Thru Troy Fain Insurance 0OMW7019
'i ',',PF ' Bonded Thru Troy Fain Ineenmce a00a5.7019
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Rev.8/2/17