HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL JAIII PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DatPermit Number: - 0
0 11.1
SCANNEDsly RECEIVED
ui'ding Permit Application JUL 0220118
Planl ing and Development Services
Bull ng and Code Regulation Division Sr• Lucre �aynty permitting
2301,Virginio Avenue, Fort Pierce FL 34982 `
Pho�"e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
ER IT APPLICATION FOR: Gas piping.
I�
PROPOSED
IMPROVEMENT LOCATION:
Addr,
s: 12480 Harbour Ridge Blvd, Palm City FL 34990
Legal
Description: RIVERSIDE VILLAGE UNIT 3-4 (OR 4035-2127)
Prop�I�IlrtyTax
Site Pian
Proje
Setb1
ILI
ID #: 4426-510-0020-000-2 Lot No.
Name: Block No.
t Name: Beaudoin
cks Front 10 Back: 10 Right Side: 10 Left Side: 10
DETAILED
DESCRIPTION'OF WORK: °
InstaN;l new, gas line from meter location to range
COS STRUCTION INFORMATION:
rtiona wor to e e orme under t—checkispermit a apply:
''' HVAC IJ Gas Tank ZGas Piping _ Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
rr
TotaIISq. Ft of Construction: _
cost!,, f Construction: $ 2182.80
S Ft. of First Floor:
Utilities:nSewer 11 Septic Building Height:
O\gNER/LESS'EE:
. ;
CONTRACTOR:
Name
Adcl
City;
Paula Beaudoin
Name: Gamaliel Portales
Company: Ferrellgas
Address: 3232 SE Dixie Hwy
' ss:12480 Harbour Ridge Blvd
Palm City State: FL
Zip'
II
ode. 34990 Fax:
l e No. 772-283-0553
City:. Stuart State: FL
Zip Code: 34997 Fax: 772-287-3456
E-M
Fill i
III:
Phone No. 772-287-4330
alen
E-Mail: emir Y9 @ferrell 9as.com
fee simple Title Holder.on next page (if different
fro
the Owner listed above)
State or County License: 30558
if val.0e of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
a -
SUPILEMENTALCONSTRUCTION, LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
III
Name: THOMAS COLLINS
Name : GAMA PORTALES
Address: 9519 LAURELWOOD CT.
Add r6ss:9519 LAURELWOOD CT. FORT PIERCE, FL 34951
City: IfORTPIERCE' State:
City: STUART State:
Zip: "1 Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Nam,p:
BONDING COMPANY: Not Applicable
Name:
Address:3232 SE DIXIE HM
Address:
City:
III
city:
it Phone:
Zip: Phone:
Zip:
OWN' R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi that no work or installation has commenced prior to the issuance of a permit.
St. Lucill County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which ig 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 fol'l!owing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessb' Iry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARDING 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
befor6 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comniencing work gr recording our Notice of Commencement.
Signs
ure of Ownerl Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE
COO,
The f
this
OF FLO A
NTY OF T MAM
STATE OF RIDA
COUNTY OF
The for oing instr me t was acknowledge before me
this May of 26 by
going instr megI acknowled before me
day of 20 by
C
maki-e l %- nAa
Pers
Type
lName of person�naking statement
nally Known i OR Produced Identification
of Identification
Name of perso making statement
Personally Known OR Produced Identification
Type of Identification
Procli
ced
Produced
Co
v C A,%A
(Sign
Commission
ature c o ary Pu ic- State of Florida)
No. :' kLEN
C !0 i GG 165462
�Ll LJ *`
!y Po a EXPIRES Decembei 5, 2021
S' OF F��• ' BOlIdBd �{� Public Undetwlitere
(Signature otaryy t�'"'' EMILYGALEN
Commission No. ecem :: COMMI� iW16592
: a• EXPIRES: D beFS, 2021
'FOF�opow Th ru Nc�Y Public U�ertvriters
REVIEWS
FRONT
ZONING
SUPERVISOR
!PLANS
VEGETATION
SEA TURTLE
MANGROVE
I
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATA
RECEIVED
DA
COMPLETED
Rev. 8
2/17