HomeMy WebLinkAboutBUILDING PERMIT APPLICATION04 20t9 14:00:20 Via Fax St. Lucie Cory'"tl Page 002 Of 002
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 03/OW2019
Planning and Developmentservices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft. 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: Gas piping
Permit Number: \03�a4�5
=RECEIVEDPermit Application
Commercial — Residential x
YLU '
Address: 12739 Refuge Lane Jensen Beach FL RY
Legal Description: MEN'S REFUGE LOT 2 (OR 3920.2801) St. Lucie County
Property Tax ID #: 4504-702-0003-000.5
Site Plan Name:
Project Name: i
Setbacks Froi
Back: I O Right Side' �m _- Left Side:y
Lot No.2
Block No.
Install Interior gas Lines and final connections to THWH, Range & Dryer, Xrl 544It ;150 -lu4 jL UUr
J,K& i'dj SU 611-S L,h� 41-
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ittona war Itoµ
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er t i p rmit c ec
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�NVAC
(e�e{`r�orme}
1� Gas Tank
®Gas
Piping
_Shutters
�
Windows/Doors
�Etectric•
(®plumbing
❑Sprinkiars
�
Generator
�
Roof
�
Roof pitch
Total Sq. Ft o'F Construction- Sq. Ft, of First Floor:
Cost of Construction: $ ^L-F �_ el) Utilities: Sewer oSeptic
Building Height:
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.. .•ter• .. n. • •'•.i ..':. ,. '... %.!,
Name Geafkey LaBarge Arne L lanniccherl
Name: Paul Draghi
Address: 1583'SE Maxim AVE
Company: Paulie Propane & Natural Gas Systems, Inc.
.City: Port Saint Lucie State: FL
Zip Code: 34952-7150 Fax:
Phone No.7721361-5061
Address: 4100 SE Salerno Road
City: Stuart State: FL
Zip Code: 34994 Fax,
Phone No, 772/220-2616
E-Mail:_
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mall: pauliepropane@gmail.com
State or County License: 24441
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
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 TOO ER: Your failure to Record a Notice of Commencem t may result in your paying twice for
improvements Jo our property. A Notice of Commencement murecorded and posted on the jobsite
before the fir in pection. If l yifu intend to obtain financing, cons It w th lender g{ an attorney before
commencing or or record'jII k your Notice of Commencement. A (1 I
Va11vi IV#/
Signature of O er/ Lessee% o tracto as Agent for Owner
Signature & ntractor Li se older
STATE OF FLORIDA
lMt% (L.X IN
STATE OF FLORIDA
COUNTY OF
COUNTY OF wft
The for oing instrument was acknowledged before me
this 7dalyofl IranA(z.C-t 20rR by
't
The for oing instrument was acknowledged before me
this �dayof PAAVrJ204C by
`T 0,uJ-�'b Rp !&,'1�
(
PaW Draghi
Name of person,rtfaking statement
Name of person making statement
Personally Known ✓ OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification ��Iltllllllllll//� 12
Produced STO��i�
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Produced ����` ERYLSr
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(Signature of Nota blic-State offlbfda )
(Signature of N to Public -State of �o iila) 0'
({ n OF909203 :ae`
Commission No. l�vl �nrxahN v� oQ:
of ®FF909203 •�`
Commission No. VI Oq 2 03 �9�a1nN o . 2��
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17