HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONing and Development Services
ng and Code Regulation Division
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578 Commercial
P�RMIT APPLICATION FOR: Gas tank
APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
te: 1 0 _ tq- i Permit Number:
Building Permit Application
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"PROPOSED IMPROVEMENT.LOCATION:
A �dress:ry Y�Gs'
V vSeANNED
Legal Description: OLMSTEAD PLACE S/D LOT 4 (OR 1884-2557) BY
St Lucie County
Property Tax ID #: 3412-502-0004-000-3 Lot No. 4
Site Plan Name: Block No.
Project Name: Complete Electric/Struve
Se I tbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION WORK
.mow....FI]............... �� .,,. .. ..,... ......... �...� r.,....... .......,...... rN.�.
HVAC , Gas Tank Gas Piping _ Shutters Q Windows/Doors
ElElectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Totl I Sq. Ft of Construction: S . Ft. of First Floor:
Cos of Construction: $ 4974.15 Utilities: 0 SewerEl Septic Building Height:
"OWNER%LESSEE: = . °'
CONTRACTOR ..
Name I Al c I r)f�- skY10-y"9-
Name:
Address: Coo 9 0 CI J w D I (U:1 a tw/, —
Company: Ferrellgas
City: crc& State: FL
Address: (all
Zip Code: 34982 Fax:
City_ : C-s�e��q ' C ir4 5 State: FL
Phone No.' -I- l a
Zip Code: 34997 Fax: 772-287-3456
E-Mail:
Phone No. 772-287-4330
Fill in fee simple Title Holder on next page (if different .
x' KimWilkins ferrell as.com
� E-Mail: @ 9
fromi the Owner listed above)t
State or County License: 395b'8 501-4 Q
If value of construction is $2500 or more, a RECORDED Notice'of Commencement is required.
SUPPLEMENTAL C;04NST.RUCTION LIEN LAW INF,Q I,, ATIQN a
,�..
INEER: / Not Applicable
N a m e: THOMAS COLLINS
Add ress: 9519 LAURELWOOD CT. FORT PIERCE, FL M951
City: FORTPIERCE' State:
Zip• Phone
FEE SIMPLE TITLE HOLDER: /Not Applicable
Name:
Address:3232 SE DIXIE HWY
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
N a me: GAMA PORTALES
Address: 9519 LAURELWOOD CT.
City: STUART State:
Zip: 'Phone•
BONDING COMPANY: /Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certlfy 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, bylaw's 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.
Thei 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 recordingyourNotice of Commencement.
re of Owner/ Llessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF YYl (iY n
The forgoing instru ent was acknowledged before me
this day of C 20,1'by
Name of person aking statement
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notary f fiblic- State of Florida )
Commission No.
REVIEWS
FRONT
ZONING
COUNTER
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. V2/17
Signature of Contractor/License Holder
STATE OF FLORID
COUNTY OF (Icl n
The forgoing instrument was acknowledged before me
this day of d Y___, 201S by
Giamo'l-i(i A(- IrL15
Name of per�soqf6aking statement
Personally Known V OR Produced Identification
Type of Identification
Produced
)VD-9 �Anlr
(Signature of NotaryAblic- Stafe of Florida )
)eaK1MBERLEYL WILKINS Co mission No. �/r
MY COMMISSION # FF 063 � 05 U 1. �O�
EXPIRES: November28, 20 1 111
nMletary Pab1I
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
1-KIMIERLEY1, WILKINS
MY COMMISSION # FF 06310.
EXPIRES: November _8, 2021
REVIEW I REVIEW