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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 1
m
- 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 Commercial Residential
PERMITTYPE:Gas tank and line
PROPOSED IM',ROVE MENT;LOCATIO.N,
Address: 3212 Live Oak Ln
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Property Tax ID #: 243050200550008 Lot No.55
Site Plan Name: Bennett Block No.
Project Name: Bennett
D TAILED DESCRIPTION QF WORK g
Supply and install 250 gallon Ip tank underground with gas line to generator and final connect
CON�STRUCTIONJNFORIVIATION: _
`Additional
work to be performed under this permit — check all that apply:
_Mechanical i/GaS Tank 1/ Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing _ Sprinklers Generator Roof Pitch
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 10,595.00 Utilities: —Sewer _Septic Building Height:
0wN WLESSE,E
CONTRACTOR
NameTiffany Bennett
Name: Blake Cowdell
Address:3212 Live Oak Ln
Company: Energized Ga .
City: Fort Pierce State: _
Address:4212 Bandy Blvd
Zip Code: 34981 Fax:
City: Fort Pierce State: FI
Phone N 0. 772-216-0224
Zip Code: 34981 Fax: 772-318-6672
E-Mail:
Phone N0772-466-1095
Fill in fee simple Title Holder on next page ( if different
E-Mail energizedgenerators@gmail.com
State or County LicenseFL34747
i
from the Owner listed above)
If
value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If
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value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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,SUPPLEMENTAL CONSTRUCTION LIEN.LAW INEO.RMATION
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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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Luc,1e-
COUNTY OF 51, umi e,
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
I
this 2tA day of 'Ssind& 20 1t by
this ,'lam day of Tune, 20 I t by
10.k.2 cowjell
"3�g�.e Cowde lf
Name of person making statement.
Name of person making statement.
I
Personally Known >C.— OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notar "' ate !gyp®�T�
(Signature of Notary Pub i ' e'of FI
='i MY COMM)SgION # FF963031
Commission No. i'F 6 EXPfR
": '4 Iv9Y COMMISSION # FF963031
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Commission No. fF ; •, EX� May 04, 2020
Y04,2020
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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