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Home My WebLink AboutSUBMITTED PAPPERSS Q 004all trallu 1-0Illy MASTEVERMIT: ,t ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE FORT PIERCE, FL 349825652 561-462-1553 APPLICATION FOR GAS PERMIT SEE REVERSE SIDE FOR INSTRUCTIONS 056� - o c9-75 SCANNED BY St. Lucie County DATE: 1. LOCATION/SITE ADDRESS: 1:;/el -3 +'1; '4-7 J�.d �[%4;y 2. PARCEL ID NUMBER: 1, O l vU 41' Uco SECT I TWP RNG MAP ZNG LU INIT 3. DESCRIPTION OF PROJECT OR WORK ACTIVITY: e' PLEASE ATTACH DETAIL PLAN OF WORK. 4. OWNERS INFORMATION v1� Name: 2:ff'Cl/� � }T�K q� Address: G!o 3 T7t"'/U✓v4 /G.q! /V#Y v � City: �� /7 r1 C-2�_ State: Phone: �9J �,� / Zip: 5. CONTRACTORS INFORMATION FL REG/CERTM COUNTY CERT M I Business Name: 6. VALUE OF CONSTRUCTION: $ 122f9rJ. 92Z FEES DUE: RECEIPT: OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in compliance with all applicable laws regulating construction and zoning. PRINT QUALIFIERS/OWNERS NAME / JSIGNATURE OF QUALIFIER/OWNER STATE OF FLORIDA, COUNTY OF CC(/ j �^ SWORN TO AND SUBSCRIBED BEFORE ME THIS [ bb,DAY OF n,I VZ , 20 BY ,��\4� ee v�rr�� J✓•+ �� WHO IS PERSONALLY OWN TO ME OR WHO HAS PRODUCED D/- �1-L AS IDENTIFICATION S530Liz1be0ggD SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY NOTARY PUBLIC TITLE COMMISSION NU Y'/i,- BARBARAA COUNSELLOR ++ PAY COMMISSION# DD436835 EXPIRES: June 2, 2009 NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT .,Tn.... �R°PgRGNO11N'9l6BImEoSs IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CON _ ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. - ST. LUCIE COUNTY GAS PERMIT INSTRUCTIONS Please complete all information in thespaceprovided- All information_ must be Printed (use black or blue ink only) or Typed. This application for Gas Permit to be used for only those activities that are not otherwise included under a primary building permit. This application for Gas Permit may not be used for any activity that includes any type or kind of structural alteration. Building activities involving structural alteration, in addition to the gas work, must be permitted through the regular building permit review process. The information to be provided with this application includes: LOCATION/SITE ADDRESS:..... 2. PARCEL ID NUMBER%. 3. DESCRIPTION OF PROJECT OR WORK ACTIVITY........ 4. OWNERS INFORMATION: ............ ..................... .............. 5. CONTRACTORS INFORMATION:.... 6. VALUE OF CONSTRUCTION: ............... Indicate the street address, or general location, of the property on which the building activity is taking place. Indicate the Property Tax Identification Number for the property on which the building activity is taking place. Briefly describe the building activity under permit application. Indicate the name and address of the owner of the property on which the gas repair or replacement is taking place. Indicate the State of Florida (if applicable) and St. Lucie County contractors registration numbers, and the name of the business doing the gas work. Indicate the total value of the gas work to take place. Total cost of construction includes all material and labor _costs associated with the building/construction activity. The value of construction is used to determine the amount of permitting fees to be assessed. St. Lucie County reserves the right to question and/or modify the indicated value of construction if it is demonstrated that the submitted figures are not consistent with similar types of construction. All applications for Gas Permits are to be submitted to the St. Lucie County Building and Zoning Department, St. Lucie County Administration Building, 2300 Virginia Avenue; Fort Pierce,' FL,34982. All applications for Gas Permits must be complete and filed with the Department no later than 4:30 P.M. each business day. No applications will be accepted for processing after 4:30 P.M. For assistance in completing this application, please contact the St. Lucie County Building and Zoning Department, at (561j 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday. Following the issuance of the Gas Permit, all scheduling of required inspections may be made by calling (561) 462-1261. SLCCDV FORM NO.: 009-05 e Code Compliance Division BUILDING PERMIT 2300 Virginia Avenue FL Pierce, FL 34982 Phone: (772) 462-1553 Fax: (772)462-1166 Page 1 Issued: 07/18/2005 Conf M 547 Permit #: SLC- 0507-0675 Job Location: 6103 Arlington Way City: FORT PIERCE Permit Type: Gas Piping Job Description: INSTALL 250 UG TANK AND LINE TO GENERATOR- Subdiv: Portofino Shores Lot: Block: Parcel: 1312-501-0091-000/3 Contractor SMITH JAYCE PROPAN_E_DISEOUNTERSJ-C (ZZ2)225_7980 739 NE DIXIE HWY JENSEN BEACH, FL 34957 Property Owner Michael Smith (772) 595-5951 6103 Arlington Way Fort Pierce, FL 34951 Property Owner Delia Smith ( ) 6103 Arlington Way Setbacks Left: Right: Number of Units: 1 Floors: 1 Minimum Floor Elevation: Job Value: $1,700.00 Fort Pierce, FL 34951 Front: Rear: Zoning: Buildings: 1 Square Footage: 0.00 Flood Map: Flood Zone: Elev: Permit holder acknowledges through acceptance of this permit that separate permits must be obtained as required by the Standard Building Code including those for all electric, plumbing, mechanical, roofing, and structural work. Further, he/she acknowledges responsibility to to comply with all requirements of the 2001 Florida Building Code. NOTICE: In addition to the requirements in this permit, there may be additional restrictions applicable to this property that may be found in the records of this County, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. s:553.79(10), F.S. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR BUILDING IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT..s.713.135, F.S. Building Official Date For Automated Inspections, Call (772) 462-1261 For Questions, Call (772) 462-2172