HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Permit Number: ()tQ • 0Lq-1 1
Date:
SCANNED
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT: APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION:,
Address: 9531 SHADOW LN
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Commercial Residential X
Legal Description: MONTE CARLO COUNTRY CLUB -UNIT TWO- LOT 215 (OR 3970-1750: 4057-2932)
Property Tax ID #: 1334-502-0096-000-9
Site Plan Name:
Project Name: COMPLETE/MYKOLYN
Setbacks Front 10 Back: 10
�. DETAILED DESCRIPTION OF WORK:
Right Side: 10
Left Side: 10
on 9 ti, Nnr
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Lot No.215
Block No.
INSTALL 500 GALLON LP GAS TANK AND LINES TO GENEFf
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CONSTRUCTION INFORMATION:
laitional work to e e orme un er t is permit— check a apply:
HVAC Gas Tank ❑� Gas Piping _Shutters
o
0 Electric 0 Plumbing Sprinklers I Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 3700.85
S Ft. of First Floor: _
Utilities: Sewer E]Septic
QWindows/Doors
11 Roof Roof pitch
Building Height:
OWNER/LESSEE: , .
CONTRACTOR:
Name MICHAEL T MYKOLYN
Name: GAMALIEL PORTALES
Address: 9531 SHADOW LANE
Company: FERRELLGAS
City: Fort Pierce State: FL
Address: 3232 SE DIXIE HWY
Zip Code: 34951 Fax:
City:,STUART State: FL
Phone No. 772-409-4497
Zip Code: 34997 Fax: 772-287-3456
E-Mail:
Phone No. 772-287-4330
Fill in,fee simple Title Holder on next page ( if different
E-Mail: EMILYGALEN@FERRELLGAS.COM
from ,the Owner listed above)
State or County License: 30558
If value at construction is $2500 or more, a REcoRDEO Notice or commencement is requirea.
Name:
Address:.'
City: State:
Zip' Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone: —
MORTGAGE COMPANY: _ Not Applicable
Name: --
Address: _
City: State:
Zip: Ph, one•
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
UWIVCK/ LUN I KAL I UK 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 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
commencing work or recording vour Notice of Commencement.
Signature of Owner/ LLssee/Contractor as Agent for Owner I Signature of
Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF i�� 11�-11i� COUNTY OF I(�i�{�`jl Vi
The r oing instr ment was acknowledg�eed before me
this day of VQ 201% by
C;?.tags l ?Mak?s
Name of perso aking statement
Personally Known ZOR Produced Identification
Type of Identification
Produced
The forgoing instru ent wasacknowledged before me
this ay of �i�
. 20AI by
Name of persorvtnaklng statement
Personally Known L1 OR Produced Identification
Type of Identification
Produced
lv\
(Signature of t@ary Public- State of Florida) (Signature of o ary Public- State of.Florida )
Commission No. : t Y°:'°Commission No. J.J=
E EN
S=EXPIRES:December5,202i
I U S4 (cs �. MY COMMISSION # GG 165462 'o • _ a EXPIRES: December
;Underwrilters,Q5,
ere
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGRO E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17