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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/18/19 Permit Number:
RECEIVED
r Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE:GAS
Address: 20 NETHERBY AVE JENSEN BEACH FL, 34957
Property Tax ID #: 4509-801-0004-020-7
Site Plan Name: SWARINGEN
Project Name: SWARINGEN
EXTERIOR LP GAS TANK AND LINES TO GENERATOR
Additional work to be perfumed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping utters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:.
Cost of Construction: $ 2400
NameRandy D Swaringen Mimi Swaringen
Address:20 Netherby Ave
Sq. Ft. of First Floor:
Lot No.2
Block No.
Windows/Doors
Roof Pitch
Utilities: —Sewer _Septic Building Height:
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No. (772)220-9678
E-Mail: emcintosh@elitegasco.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Cheyenne Ellison
Company: Elite Gas Contractors
Address:2130 Poma Drive
City: Palm City State: FL
Zip Code: 34990 Fax: (772)220-1829
Phone No (772)220-9678
E-Mail emcintosh@elitegasco.com
State or County Licens 18
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
WE 10
ONE
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
S tuo of Owner/ Lessee/Contractor as Agent for Owner
Sign e o ontractor/License Holder
STATE OF FLOR
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The forgoing instrume t was acknowledged before me
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Name of pers6n maki7OR
Name of son making
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Personally Known Produced Identification
Personally Known
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Type of Identification
Type of Identification
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Expires 12/11/2022
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DATE
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DATE
COMPLETED
Rev. 2/7/19