HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
ate: 07/18/18 Permit Number: ��� '�✓�-f '
�T`SCANNED
' B/ RECEIVED
BuildIng;r#lit Application DUI ,2 0 2018
ning and Development Services
ling and Code. Regulation Division Permitting Department
) Virginia Avenue, FortPierce FL 34982 St. Lucie County
ne: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PE�MIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
AddiI ess: 9529 Shadow LN
LegI Description:. MONTE CARLO COUNTRY CLUB -UNIT TWO- LOT 216 (OR 4606-124)
Prop'�rty Tax ID #: 1334-502-0097-000-6 Nf I Lot No. 216
ta -1 `-5.
Site Ian Name: Block No.
Pill t Name: Juillerat
Setblp,cks Front 10 Back: 10 Right Side: 1O Left Side: �kO
INSTALL NEW GAS LINE TO GENERATOR FROM EXISTISTING LP GAS TANK
1f�,y�0..r i, Y. .., 913F0iSrF'.k �Fl -
t- _�
CONSTRUCTION INFORMGATION �f 9 �a...�,°;�:�"s.��:,.",f�'` °>
Ad it. na wor to be nerformed under tispermit—check all apply:
VAC Gas Tank 7Gas.Piping _ Shutters Q Windows/Doors
ectric 0 Plumbing 0Sprinklers O Generator Roof Roof pitch
Total SIT Ft of Construction: S . Ft. of First Floor:
Cost of!,,, onstruction: $ qa3- !-1 5 Utilities: 0SewerE1Septic Building Height:
OWNBR LESSE4yE
v 1,£
Name D11na Juillerat
Name: GAMALIEL PORTALES
Company: FERRELLGAS.
�
Add ressi9529 Shadow LN
City: Fd%t Pierce State: FL
Address: 3232 SE'DIXIE HWY
Zip Cod4: 34951 Fax:
City: STUART State: FL
Phone N4.
34997 772-287-3456
Zip Code: Fax:
E-Mail: ,�I
Phone No. 772-287-4330
Fill in feelsimple Title Holder on'next page (if different
E-Mail: emilygalen@ferrellgas.com
from theljOwner listed ' above)
State or County License: 01237
If value of,'construction is $2500 or more, a RECORDED Notice of Commencement is required.
k So LEMENTAL`
CONSTRUCTION LGEN=LAW
1NFOR'MATIQN
•_
-_
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
Not Applicable
N a m e: THOMAS COLLINS
N a me: GAMA PORTALES
_
Add ress:9519 LAURELWOOD CT. FORT PIERCE, FL 34951
Address: 9519 LAURELWOOD CT.
City: STUART
State:
City: FORT PIERCE' State:
lzip: Phone
Zip: Phone:
I EE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY:
_Not Applicable
�ame:
Name:
Address:
ciclress:3232 SE DIXIE HWY
plCity•
City:
Zip: Phone:
Zip: Phone:
OYNNER/ CONTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to do the work and installation as indicated.
I gertify that no work or installation has commenced prior to the issuance of a permit.
St jI ucie 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
str" cture. 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 a'1 cordance with the approved plans, the Florida Building Codes and St, Lucie County Amendments.
Thel,'following building permit applications are exempt from undergoing a full concurrency review: room additions,
acc�ssory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WA NING 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
coi l,mencing work or recording vour Notice of CommphrPmPnt_
,Ilfl
Signature of Contract0 /License Holder
Sig 'I ture of Owner/ Le see/Contractor as Agent for Owner
STATE OF FLOFI�
COUNTY OF 1`"�(A,y( -n
STATE OF FLORID
COUNTY OF P- rA.V �.�,�
'aIo�r
The oing ins ment was acknowled a before me
this 4 � day of 1 203 by
The forg in instr me t was acknowledg d efore me
thhis Uday of 20 by
Name of person aking statement
Name of pers making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type? Identification
Produced
Type of Identification
Produced
r
a
(Signature of N t
(Signature o of ry P G e o
'o'••••• ILY GALEN
EMI YGALEN
ComrrilLlon No.
_:; :. MYCO �S�I #GG165462
EXPIRES: Decemt�er 5, 2021
=.: MY Co I,S I N#GG165,62
Commission No. ,,��SS QQ
EXPIR �$eMer
VA01L � D—
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Bonded Thru Na Public Underwriters
$F`Y
Q,, 5, 2021
t r p �OF "°' Bonded Thru No
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE �
COMPLETED
tev. 8/2/17