HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9AILV19 Permit Number:
- SCANNED
BY RECEIVED
St. Lucie County
Building Permit Applic t101`16[;P 16 ' '?
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitung
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
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Address: 905 S HEADER CANAL RD
Property Tax ID #: 2214-501-0005-000-6
Site Plan Name: MCCORKLE
Project Name: MCCORKLE
INSTALL EXTERIOR LP TANK AND LINES
Additional work to be performed under this permit— check all that apply:
_Mechanical XGas Tank )(_ Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:_
Cost of Construction: $ 4600
Sq. Ft. of First Floor:
Lot No.5
Block No.
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
NameJames R McCorkle III
Name: Cheyenne Ellison
Address:16501 Carlton Adams RD
Company -.Elite Gas Contractors
City: Fort Pierce State: _
Zip Code: 34945 Fax:
Phone No.(772)220-9678
Address:2130 Poma Drive
City: Palm City State: FL
Zip Code: 34990 Fax: (772)220-1829
Phone No(772)220-9678
E-Mail:emcintosh@elitegasco.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailemcintosh@elitegasco.com
State or County License 18361
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.
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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:
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 antl 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."
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Si re of caner/ Lessee/Contractor as Agent for Owner
Sidpthfef Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORI A
COUNTY OF Qr4m
COUNTY OF %k r-- r)
The forgoing instrument was acknowledged before me
The for oing instrument was a knowledged before me
this day of !O� 20_& by
this day of rS�C/NeY . 201_q by
Q1eue2ne F at-)
Ch2uevlle rn
Name off rson makings tement.
Name of p on making tatement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- Slat o 0,10. 1 ign ur otary Pu lic-Stat o
.O Notary Public State of F 4" Notary Public State of FI�
Aesiree N McIntosh free N McIntosh
Commission No. a 83 y(Sbal ycommisiub, GG 28 349]m ssion No. 1�9 rJ dd mmis�lan GG 287:
p Expires l2/112022 4Rd1r Expires IV11f2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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