HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8/13119
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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PERMITTYPE: LP GAS - RESIDENTIAL
PROPOSED IMPROVEMENT LO CATION: 1405 LONE PINE DR, FORT PIERCE, FL 34982
Address: 1405 LONE PINE DR, FORT PIERCE, FL 34982
Property Tax ID #: 3409-505-0022-000-4
Site Plan Name: CLEMONS
Project Name: CLEMONS-LONE PINE SUBDIVISION
DETAILED DESCRIPTION OF WORK:
INSTALL 500 UNDERGROUND LP TANKAND LINES TO .'
Lot No.17
Block No.
DRYER, STOVE AND B13Q.
I CONSTRUCTION INFORMATION: I
Additional work to be perforryed underthis perrr}it—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 6347.35
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Maximilian Clemons
Name: Gamaliel Portales
Address:1202 Parkland Blvd
Company: Ferrellgas
City: Fort Pierce State:
Zip Code: 3482 Fax:
Phone No. 772-418-6644
Address: 3232 SE DIXIE HWY
City: Stuart State: FL
Zip Code: 34997 Fax: 772-287-3456
Phone No 772-287-4330
E-Mail: maximillianclemons@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail KimWilkins@ferre m
State or County Licens 30C%
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.
Name: — --_
Address:
City: State:
ZiP: Phone
FEE SIMPLE TITLE HOLDER: _ Name: Not Applicable
Address:
City:
ZIP: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
city: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain apermit to do the work and installation as Indicated.
1 certify that no work or Installation has commenced prior to the Issuance of a permit
whtchcis,n cb 71cmt with any applicable HomeaOwnerstAssopationRrules bylaws or anscovenants that build
drestrict 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 Nenrr nsc rnmwm.Y..�n
Signa�f 0 er/ Le ontractor as - Agent far Owner
STATE OF FLORII/ a� �
COUNTY OF_(_p STATE OF FLORIDA
COUNTYOF "Y 'n
day of °
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person
Personally Known V OR Produced identification
Type of identification
Produce .
(Signature of Notary
•:a"° KIMB RLEYL WILKINS
Commission No. ,@ MYISSIQN#FF 0831D5
FES: November28,2021
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Name of person making statement.
Personally Known,/ OR Produced Identification
Type of Identification
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