HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE
ACCEPTED
Date: srlAn1mPermit Number: 1� 06'd3�3
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St. LucieCoft
Building Permit Application
Planning and Development Services _
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMITTYPE:GAS PERMIT
PROPOSED IMPROVEMENT LOCATION:
Address: 179 SE FLORESTA DRIVE PORT ST LUCIE 34983
Property Tax ID #: 3419-530-0166-000-4 Lot No.15
Site Plan Name: RIVER PARK -UNIT 4 BLK 38 LOT 15 (MAP 34/28N) (OR 1340-796) Block No. 38
Project Name: GAMEZ GAS LINE REPIPE
DETAILED DESCRIPTION OF WORK:
RUN EXISTING GAS LINE FROM METER FOR COOK TOP STOVE
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank X Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1325
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: _
CONTRACTOR:
Name Heriberto Gamez
Name:ROBERT LUDLUM
Address:179 SE Floresta Or
Company- BENJAMIN FRANKLIN PLUMBING
City: Port St Lucie State: Fl.
Zip Code: 34983 Fax:
Phone No.
Address-1631 SW SOUTH MACEDO BLVD
City: PORT ST LUCIE State: FL
Zip Code: 34984 Fax: 772-871-9069
Phone No772-871-9494
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail PERMITS@BENFRANKLINPLUMBER.COM
State or County LicenseCFC1426801
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 LAW INFORMATION: =
x Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable I BONDING COMPANY: _Not Applicable
Name: - -
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. -
no
:e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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
"YARNING 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."
Signa a of r ee
or as Age or Owner
Signature . ontra or/License o der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFSAINT LUCIE
COUNTY OFSAINT LUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of
20 by
this _ day of 20_ by
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Name of person making statement.
Name of person making statement.
Personally Known V OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatt f Notary Public-
i
S'gna r of Notary Publi
Commission No.
�Ws Note ly Public State of Florida
(5@SIIA Graham
�9 N0�7?°WI° 5taIs of Florida
C mission No. Les] ham
My Commission GG 299602
= e` My Commission GG 299502
p, Expires 01/30/2023
Expires 01/30/2023
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