HomeMy WebLinkAboutBuilding Permit Application II
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: If s 15— 1 5 Permit Number: i b' .1 ` — DS-9)r)
`COUNTY
Building Permit Application RECEIVED
Planning and Development Services Pe NOV Y 5 2018
Building and Code Regulation Division rmittin
2300 Virginia Avenue, Fort Pierce FL 34982 St Lu a Countment
Phone: (772)462-1553 Fax: (772)462-1578 Commercial x Residential 3'
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 5090 Dunn Road
Legal Description:
Property Tax ID#: 31A O3- 5OY" saa/4' O0J3 Lot No.
Site Plan Name: Block No.
Project Name: Hospice Lift Station undergrounf service relocation
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Relocate underground service lateral to existing lift station Lift Station belongs to City of Pt. St. Lucie
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all h apply:
❑HVAC _Gas Tank Gas Piping Shutters I, 'Windows/Doors
✓ Electric . ❑ Plumbing .Sprinklers 0 Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S�of First Floor:
Cost of Construction:$ 2,482.00 Utilities: Sewer Septic Building Height: '
OWNER/LESSEE:City of Pt. St. Lucie Utilitiesti�` CONTRACTOR:Paragon electric of Vero, Inc. '
Name )VFranklin(Electrical Systems Super.) "j"` keame: Tom Granims
Address:900 SE Ogden Lane aet5e--11,aco* `Company: Paragon Electric of Vero, Inc
City: PSL S\ ate:FL Address: 9120 15th Place
Zip Code: 34983 Fax: `IC17 City: Vero Beach _ _ State:Fl
Phone No.772 873 6408 Zip Code: 32966 Fax: 772 299 5167
1
E-Mail:wfranklin@cityofpsl.com Phone No. 772 569 8961
Fill in fee simple Title Holder on next page(if different E-Mail: paragonelectric@bellsouth.net
from the Owner listed above) State or County License: EC0002731 '
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable;
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:9120 15th Place 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 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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owne /Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5A- L Lt i C. COUNTY OF cjd'A-►J Ie-GJ
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of it)d /. ,20 i�by this /a day of WeVe#9aA% 2. ,20/f by
ltv, 6-ran inn S T L 4t2m-ditn0
Name of person making statement Name of persoJn naking statement
Personally Known OR Produced Identification ✓ Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced VL L. OA_ Produced
41:.:.a- Kea[WI:NEWER
(Signature of Notary Public-Sta a of Florida) (Signature of Notary Public-State 4or•
at� Commission#GG04618b
.41
E?Ores November 9 2)2:
ELLENNA GHN .
Commission No. ,•``�sYP�'% Commission No. Qat'fir 8'� �%%f°..�•h-
�f;-Stdte of Flora a tart' Public T1wTroyFainlnwranceE4?�3851019
nn.440.
Commission #GG 270079
;No If`O • My Commission Expires
` October 22, 022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17