HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1/8!2019
Date: Permit Numb r-
..� EIV
ED
NO ---11 Building Permit Applicatio JAN 0 g 2019
Planning and Development Services Permittin
Building and Code Regulation Dlvlslon g Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. cie CO u n t FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial x Yr
PERMIT APPLICATION FOR: Electrical
Address: 5601 N A1A,FT PIERCE,FL 32949
Legal Description: AVALON STATE PARK
Property Tax ID#: 1409-111-0001-000-6.0 Lot No.
Site Plan Name: Block No.
Project Name: AVALON STATE PARK
Setbacks Front Back: Right Side: Left Side:
REPLACE PANEL METER CAN AND FUSED DISCONNECT FED FROM FPL METER#AC89 150
THIS IS THE SERVICE FOR THE RESTROOMS NEAR THE OCEAN
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itional worK to be performed underthis permit—checK all appy: i
❑HVAC 0 Gas Tank ❑Gas Piping CGenerator
Shutters aWindows/Doors
Z✓ Electric 0 Plumbing Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 2400.00 Utilities:12 Sewer O Septic Building Height:
Name STATE OF FLORIDAIAVALON STATE PARK Name: GARETT GUIDROZ
Address:3900 COMMONWEALTH BLVD Company: COMPLETE ELECTRIC INC
City: TALLAHASSEE State:FL Address: 637 SEBASTIAN BLVD
Zip Code: 32399 Fax:772460-6436 City: SEBASTIAN State:FL
Phone No.772468-4007 Zip Code: 32958 Fax: 772-388-2411
E-Mail:flna.burchfield@floridadep.gov Phone No. 772-388-0533
Fill in fee simple Title Holder on next page(if different E-Mail: mskelley@completeelechicinc.com
from the Owner listed above) State or County License: EC0001911
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: ____Not Applicable
Name: Name:
Address:637 SEBASTIAN BLVD 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
cornmencing work or recording our Notice of Commencement.
Signature of Owner/Lessee Contractor as Agent for Owner S gnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLUCIE COUNTY OF srLuar;
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 8 day of .IAmmy ,20r by this a day of JAN(JARY 20, by
GARETT GUIDROZ GARETT GUIDROZ
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notaryubli -State of Florida} (Signature of Notary 6U -State of Florida)
Commission No. FF901W4 9 Commission No. FF901
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nosy 00s Notary Pu lo S(ole of Florida 2o�c� ue�� Nntary Pu61c 'ta a of Florida
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M COmmiflalon FF F1015A4 c a My Commission 1'F 904564
too Expirse 09 1012019 0,
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DATE
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COMPLETED
Rev.8/2/17
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