HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building permit Application ,
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1576 Commercial x Residential
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 3882 Selvitz Rd #CAN Fort Pierce 34981
Legal Description: right -of
Property Tax ID #: 2432-222-0003-000-6 Lot No._
Site Plan Name: SP - 3882 Selvitz Rd #CATV Block No.
Project Name: Comcast Power Supply
Setbacks Front Back: Right Side: _ Left Side:
DETAILED DESCRIPTION OF WORK:
Install new Comcast power supply cabinet & FPUA hand box on the north side of pole 28146 located
on the east side of Selvitz Rd, approx. 735 ft south of Glades Cut Off Rd
CONSTRUCTION INFORMATION:
CONTRACTOR:
Name_ Comcast - David Eddins
Name: Gary J Gifford
Company: Gary J Gifford, Inc.
A-dU—itional work to be nertormed un er t ispermit - check
HVAC U Gas Tank 7Gas Piping
a appy:
Shutters
a Windows/Doors
Zip Code: 33410 Fax:
City: Stuart State: FL
_
Zip Code: 34997 Fax: 772-219-0146
Phone No. 772-286-0954
ZElectric Plumbing
E]Sprinklers
F1 Generator
E]Roof
I State or County License: EC13001574
Roof pitch
Total Sq. Ft of Construction: 8
Sq. Ft.of First Floor:
Cost of Construction: $ 609
Utilities:
IJ Sewer El Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_ Comcast - David Eddins
Name: Gary J Gifford
Company: Gary J Gifford, Inc.
Address: 3960 RCA Blvd, Ste 6002
Address: 350 SW Linden St
City: Palm Beach Gardens State: FL
Zip Code: 33410 Fax:
City: Stuart State: FL
Phone No. (561) 688-6883
Zip Code: 34997 Fax: 772-219-0146
Phone No. 772-286-0954
E -Mail: david.eddins@comcast.com
Fill in fee simple Title Holder on next page ( if different
E -Mail: 9lffelec@comcast.net
from the Owner listed above)
I State or County License: EC13001574
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State: _
Zip: Phones _
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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, l 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.
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Signature of Con cto /License Holder
Signature of 0 Lessee Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Martin
COUNTY OF Min
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 26th day of April 2019 by
this 26 day of April 2019 by
Gary J Gifford
Gary J Gifford
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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of Notary Public- State of FI I a )
(Signature of Notary Public- State of Florid ty(Signature
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G Carrasquillo
r ' Susan G Carrasquillo
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y Commission GG 027510
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REVIEW REVIEW
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DATE
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DATE
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COMPLETED
Rev. 8/2/17