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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
— SCANNED
BY RECEIVED
• . St. )_u ie C an aaR 2 2
Building Permit ApAcation permittl 2019
Planning and Development Services St 9 oepa
Building and Code Regulation Division Lucie Cau^ty ent
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: Gas
PROPOSED IMPROVEMENT LOCATION: m
Address: 13506 NW Coco Plum Ct
Property Tax ID q: 4436-601-0026-000-4
•Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:' " ='
Install 500 gallon LP tank and tie into existing 500 gallon tank a- q�5 li n C
CONSTRUCTIONINFORMATION:''
Additional work to be performed under this permit — check all that apply:
_Mechanical YGasTank _Gas Piping _Shutters
Lot No.26
Block No.
Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 3200.00
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ronald & Joyce Marsilia
Name: Blake Cowdell
Address:13506 NW Coco Plum Ct
Company: Energized Gas
City: Palm City State: _
Zip Code: 34990 Fax:
Phone No.703-624-2313
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
It value of construction is 52500 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 LAW 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."
FD�
as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 4Q ( L`� i e STATE OF FL�EACOUNTY OFORIDA lo�� e.
COUNTY OF
The fppyg9ing instr
this W day of�
Na a o
Personally Known
Type of Idegtific2
0 was cknowledg efore me The o oing instr a was-acknowled efore me
j 20�Ibyt thjs� day of it 20Vby
statement. I Name of person
Identification Personally Known —OR Produced Identification
Type of WgntjftKation, 1 1
(Signatffre of Notary —Public- State of Florida ) (Signatuful5f Notary Public- State of Florida )
Commission No. (Seal) Commission No. (Seal)
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SUPERVISREVIEWOR I REV EW I PNS "EGETATIEVIEWON I SEATURTREV EWLE MANGROVE REVIEW
Commission # GG 237887
My Commission Expires
Julv 12. 2022
,orp� ALYSS
BLACKSHEA
state of
1rida-NotervPubl c
•= Commi
Sion # GG 237881
o>? My Co
mission Expires