HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �I-Z��/6 Permit Number:
SCANNED
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Planning and Development Services
Building and Code Regulation Division NOV Z (S '_:J
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial XXXXX Residential PERMITi:., --
PERMIT APPLICATION FOR: Gas piping III
PROPOSED IMPROVEMENT LOCATION: III
Address: 10867 S OCEAN DR, Jensen Beach
Legal Description' WINDMILL NLL GEBY-T E,SEA-REP TPARCEL NO 2ANDFWMSW MR SEC 123741 RUN N890MMMN41 SEC EALGSSECL1729.19F T0W YRNYAIA.TH
1 EGWNnGE349 YW31 SEGW 12 ".CSMDEGWY =SECW191M".M3WDEGWMXMEKE 111M F..TXNDEG W WN 22GE;E 247MFW MS(GR99214EM)
Property Tax ID #: 4511-809-0003-000-5
Site Plan Name: Harvest Table
Project Name: Harvest Table
Setbacks Front
Back: Right Side:
Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: III
Install 4x420# LP gas tanks and line to kitchen appliances
CONSTRUCTION INFORMATION: III
I]HVAC kd Gas Tank ❑Gas Piping
11 Electric 0 Plumbing ❑Sprinklers
Total Sq. Ft of Construction:.
Cost of Construction: $ 2389
Shutters Windows/Doors
Generator 0 Roof = Roof pitch
S Ft. of First Floor:
Utilities: []SewerDSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name EFTX LLC
Name: Jonathan Hurd
Address:4545 NE Ocean Blvd
Company: Ferrellgas
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No.
Address: 3232 SE Dixie Hwy
City: Stuart State: FL
Zip Code: 34997 Fax: 772-287-3456
Phone No. 772-233-5245
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: russellviccaro@ferrellgas.com
State or County License: 01237
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY-
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 ermit 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 jobsite
before the f st inspection. If you intend to obtain financing, consult with lender or an attorney before
commenwork or recordine vourNotice of Commencement. — _ i
W
as
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
this Z1dayof Ao vgari6e 20 Lby
FLORIDA
OF /&4"t)
The forgoing instrument was /acknowledged before me
this �day of I*Velnb2� 2041/ by
(Name of person acknowledging) (Name of person acknowledging)
(SignatwTPublic- State of Florida ) (Signature df Notary Public ate of Florida )
Personally Known X OR Produced
Type of Identification Produced
Commission No..*ACM11'0
Personally Known r_ OR Produced Identification
Type of Identification Produced s d um 11ii .
3 (� \sQ',0 6Et q4 ��04
Commission No. �ii/i3syo G
Revised 07/15/2014 tA� 'r�354os F a Q
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