HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I�
Date: 07/03/2018 ' SCANNED Permit Number: I I 1 0-4
b� BY y. ..�.: St. Lucie County __RECEIVED
Building Permit Applicatio JUL 0 5 Z018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION:
Address: 1v�.T��� �r �C�Y'`1v�,�U„ '�l_ 5CX7�LIg�Czi.
Legal Description: INDIAN RIVER ESTATES -UNIT 1- BLK2 S 32 FT OF LOT 30 AND ALL LOT 31(MAP 34/02N)'(OR 2375-2764)
Property Tax ID #: 3402-602-0074-000-0
Site Plan Name:
Project Name: HUTCHINGS
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
500 GALLON PROPANE TANK AND LINE TO GENERATOR.
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to e/ orme under this permit — check a apply:
11HVAC L"' I Gas Tank ZGas Piping _ Shutters a Windows/Doors
FlElectric Plumbing , E]Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 3150.00
S Ft. of First Floor: _
Utilities: Sewer O Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i
Address: 5bO1 r c.
City: PkQ Cesz State:FL
Zip Code: 34 qj�)OS Fax:
Name: CHEYENNE ELLISON
Company: PROPANE SERVICES INC
Address: 2130 SW POMA DRIVE
City: PALM CITY State: FL
Phone No, o'Z�''l'2_,
Zip Code: 34990 Fax: 772-220-1829
E-Mail:
Phone No. 772-220-9678
E-Mail: INFO@ELITEGASCO.COM
Fill in fee simple Title Holder on next page (if different
State or County Licen e: 18361
from the Owner listed above)
If value of construction is $2500 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:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR 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 your Notice of Commencement.
Sign re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF W gA/ N
STATE OF FLORIDA
COUNTY OF
The fopxoing instrum nt as acknowledg efore me
The forgoing instrument was acknowledged before me
this day 20_ by
this day of 20by
of ,
Name of persona -king statement
Name 6f perso aking statement
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature No ry u I -
y �VOG
(Signature of FPbi S gfFEbeidtt� of Florida
�;
Notary Public State of Florida
?o a ey L Rizza
T. Lacey L Rizz
Commission No. ' • GG I>1sa732
y • q* My Commissiory��G 8732
Commission No. 9'- Expires 12/171zba}�
mmissio�
Expires 12/1712021
,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17