HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Q�,/1/ (�
Date: l�C)�if.�_ Permit Number: V ( VITT– v r�
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Building Permit Application
Planning and Development Services permitting depart yens
Building and Code Regulation Division
St.Luc+e Coun
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE:Electric
Address: 3200 Twin Lakes Ter Ft Pierce, FL
Property Tax ID#: 1327-704-0084-000-0 Lot No.
Site Plan Name: Block No.
Project Name: Krom
PFM
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Install 120V 20AMP dedicated GFCI Circuit
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 700.00 Utilities: —Sewer —Septic Building Height:
NameSylvia Krom Name:Walter Nasi
Address:3200 Twin Lakes Ter#206 Company:S01 Electric LLC
City: Fort Pierce State:_ Address:5500 SW 43rd Ter
Zip Code: 34951 Fax: City: Ft Lauderdale State.FL
Phone No.772-465-0476 Zip Code: 33314 Fax:
E-Mail: Phone No 754-423-4105
Fill in fee simple Title Holder on next page(if different E-Mailwnasi72@yahoo.com
from the Owner listed above) State or County License EC1300 8044
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 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 TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: 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.
St. Lucie County makes no representation that is granting a permit will authorize thepermit 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
gnature f Ownneer.//Lessee/Contractor as Agent for Owner Signatur f Contractor/License Holder
STATE OF COUNTY O Li .]��Lc�}� STATE O F F LO ` um'g
"
COUNTY OF
The forgoing instrument was acknowledp4before me The forgoing instrument was ackn wledged before me
this.5 day of U 2d by this day of 20/d by
�3Q/I) I fi &�Y" d4L, . 0 Jrq s/
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known u e den I Icatio
Type of Identifl Type of Identific Notary Public
9 State of Flon
4THRYN POCKER
Produced Produced sion GG 048422
Notary Public State of Florida �� Expires 11!2112020
KATHRYN POCKER
Zemn ion 9422
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(Signatur N 1r Pu, ' (Signature of =,, ExpCime.
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Commiss n No. Seal w GG 049422
(Sea[) Commission N ! ez(Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19