HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t1
Date: 94("Zud )I-i'llr114 Permit Number: \4011
CEIVED
Building Permit Application
Planning and Development Services ` . 2 0 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ;aunty, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentia
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION:
Address: 12623 Indian River Drive
Legal Description: M 3741 FROM 8WOOROFL GBII(2 OF EMINGHI MPUN828 DEG 35 MIN E&GaYEU OF WU OF BDLOT5305.37"TO FOB. THCONTSn DEG30 MINE 75 FT.THN
91 DEG X MIN E423"MM1TOW SHOP OF IND RN. IN MY MDOIDFAMO W1NSNORE7SFTM.TOAPTV EN SSAHBN01 DEG MMW E FROM MR. TH SO,DEO]O MNWS53FTM.P0B,E88IND RN DR(OR 35642HNS)
Property Tax ID #: 4504-310-0005-000-6
Site Plan Name:
Project Name: DiLcronzo Residence
Setbacks Front 10 Back: 10
LEI) DESCRIPTION OF WORK:
Right Side: i0 Left Side: 10
Installation of 420# above ground cylinder. Run line to stove and fireplace.
ON INFORMATION:
HVAC U Gas Tank
Electric F]Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 2,358.55
Lot No.61
Block No. 2
SCANNED
�UCj� n�F..
Perrin —cnePc au
Gas Piping
Sprinklers
apply:
_ Shutters
Generator
Q
Windows/Doors
Roof = Roof pitch
13
SQ. Ft. of First Floor:
Utilities: 0Sewer 0Septic Building Height:
OWNER/LESSEE: ° _ "
CONTRACTOR:'*
Name Eva Takacs DiLoronzo
Name: GAMALIEL PORTALES
Address: 12623 S. Indian River Drive
Company: FERRELLGAS
City: Jensen Beach State:FIL
Zip Code: 34957 Fax:
Phone No.912-617-0949
Address: 3232 SE DIXIE HWY
City: STUART State: FL
Zip Code: 34997 Fax: 772-287-3456
Phone No. 772-287-4330 X22577
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: kimwilkins@ferrellgas.com
State or County License: 01237
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN; LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY
Not Applicable
Name:TMOMAsCOLLINS
Name:GAMAPORTALES
—
Address: 851E LAURELWOOD CT. FORT PIERCE, FL 34951
Address: 9519 LAURELWOOD CT.
City: FORT PIERCE' State:
City: STUART
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Ad d ress:3232 3E DIXIE WN
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 contlict 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordine vour Notice of Cnmmpni-Pmant
of
as Agent for
STATE OF FLORIDA STATE OF FLORIDA "'
COUNTY OF_M }Yn COUNTY OF YYlalri1m
The fo goin ginst ment was acknowledged before me
thisl6Ldayof 26a by
Name of person,making statement
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notary P is -State of Florida )
Commission No. Fttib631c),s ", .sepal I(IMBERLEYLW
•P@
j WCOMMISSION#
REVIEWS ILJPERVIS
COUO TER I ROEVI W I S REVIEW
Rev.
The forgoing inst ent was acknowledged before me
this da of I >' 26J2 b
Gamal e) PoY4-&16
Name of pers9n making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signature
ublic- tate of Florida )
FSEWVERLEY L WILKINS
MY COMMISSION # FF 063'
EXPIRES; November 2S, 2(
PLANS I VEGETATION URTLE J MANGROVE
REVIEW REVIEW REVIEWREVIEW