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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZA Permit Number:
SCANNED
4.4exez�Yr BY RECEIVED
e- St: -Lucie County — - - -
- Building Permit Applicatio FEB 21 2019
Planning and Development Services ST. Lucie County, permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: Gas
PROPOSED IMPROVEMENT LOCATION
Address: 15337Twin Beech Rd
Property Tax ID #: 4224-501-0031-000-4
Site Plan Name:
Project Name:
Run Gas line to generator and final connect
Lot No.31
Block No.
CO( STRUCTION,LNFORMATION t
Additional work to be performed under this p mit —check all that apply:
_Mechanical _ Gas Tank Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 695.00 Utilities: —Sewer _Septic Building Height:
„OWNER/LESSEE i
CONTRACTOR xa
Name T Mark & Patricia Jatfies
Name: Blake Cowdell
Address:15337 Twin Beebli Rd
Company: Energized Gas
City: Port Saint Lucie :,' :; State: _
Zip Code: 34987 w'- Fax:
Phone No.772-562-5714
Address:4252 Bandy Blvd
City: Fort Pierce State: FL
Zip Code: 34981 Fax: 772-318-6672
Phone N0772-466-1095
E-Mail:
Fill -in -fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail EnergizedGenerators@gmail.com
State or County LicenseFL34747
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.
SUPPLEMENTAL CONSTRUCTION -LIEN AW_ INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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.
Sign caner/ Lessee/Contractor as Agent for Owner
Signa `actor/License Holder
STATE OF FLORIDA
STATE OF FLORID l /
COUNTY OF ,1(a
COUNTY OF - ! 1 lei Pi
The f9rgoing ins t nt was acknowled a efore me
The or oing ins m nt was acknowledgg efore me
thi day of 20��r
this dayo�r��JF-ff 201�jby
Name of person making statement.
Name of person making statement.
Personally Knowno OR ed Identification
Personally Known � OR Podd Identification
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Typeof entifcatio
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