HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^�'/�
Date: 04/04/18 SCANNED Permit Number: I JQ6 • L0(DLi4
BY
U; _ St. Lucie County' _ P J�NR�Buildin Permit Application F5c
10�e
Planning and Development Services a St. 0
Building and Code Regulation Division c unKhrent
2300 Virginia Avenue, Fort Pierce Ft 34982 �"
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Gas tank
PROPOSED IMPROVEMENT LOCATION: �II
Address: 5000 Dunn RD, Fort Pierce FL 34981
Legal Description: WHITE CITY SID 05 36 40 THAT PART OF LOT 101 LYG W AND SLY OF DR DITCH 103 AND THAT PART OF N 182.40 FT
OF LOT 106 LYG W OF DR DITCH 103-LESS RD RIW AS IN OR 2824-2045- (7.55 AC) (MAP 30/05S) (OR 1121-1433: 2462-1453: 2824-2045)
Property Tax ID #: 3403-502-0194-000-3
Site Plan Name: Hospice Foundation/Martin/St L
Project Name: Treasure Coast Hospice
Setbacks Front 10 Back: 10
Right Side:10 LeftSide: 10
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK III
Install two 1000 gallon underground LP gas tanks and gas line to existing generator
CONSTRUCTION INFORMATION: III
E1HVAC Z Gas Tank ZGas Piping
0Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 10,463.25
Shutters ❑ Windows/Doors
Generator 11 Roof = Roof pitch
S Ft. of First Floor: _
Utilities:n Sewer F]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Hospice Foundation/Martin/St L
Name: GAMALIEL PORTALES
Address:1201 SE Indian St
Company: FERRELLGAS
City: STUART State: FL
Zip Code: 34997 Fax:
Phone No.772-284-6365
Address: 3232 SE DIXIE HWY
City: STUART State: FL
Zip Code: 34997 Fax. 772-287-3456
Phone No. 772-287-4330
E-Mail: dingraham@treasurehealth.org
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: mvoigtsberger@ferrellgas.com
State or County License: 30558
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION`:
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.
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
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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
— Q A6Ll Fi
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO ID -11
STATE OF FLORII 1
COUNTY OF IV
COUNTY OF fhf �f
The forggpping instrument was acknowledged before me
The for�PIng instr nt was acknowledged before me
this�fl^dayof yi7/!✓lL 20JS/by
this (Of''day of20f g by
Name of person making statement
Name of perso aking statement
Personally Known �/ OR Produced Identification
Personally Known j�OR Produced Identification
Type of Identification
Type of Identification
Produced
Produceddi
�Aa A r
(Signature of Notary Public- State f Florida
(Sign re of Notary Public- St of Florida
Commission No. 44ygN5-1 ( �N5o
Commission No.
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Rev.8/2/17