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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/09/2019 Permit Number: 1,q(t) _ gq,
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Building Permit Applicationpe nn„tt, 19
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Planning
uilding and Code Regulation Division St <4cPo°�n0
Benr
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
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PERMIT TYPE:ELECTRICAL
PROPOSED INPROVEMENT LOCATION:
Address: 12900 W.MIDWAY RD
Property Tax ID#: 3305-121-0000-000-7 Lot No.
Project Name:
DETAILED DESCRIPTION OF WORK:
BUILD NEW 125 AMP, SINGLE PHASE SERVICE FOR WATER PUMP TO FILL CATTLE TROUGH
CONSTRUCTION IN'F' ORMATION:
Utilities: _Sewer _Septic Sq. Ft. of First Floor:
Cost of Construction:$ 2,300.00 Total Sq. Ft of Construction:
FLOODPLAIN DEVELOPMENT PERMIT for structures exempt from Building Code that are in the
floodplain:
Nonresidential Farm Building: Temp. Bldg./Shed used exclusively for construction : I
Mobile/Modular for temp..construction office: Bldg. involved in distrib. of electricity:
Other: Flood Zone:_ BFE: Floodway? Y/N If Y,
No'Rise Certificate with supporting data attached?Y/N
AlLother applicable state and federal permits shall be obtained prior to commencement of
construction.
OWNER/LESSEE: CONTRACTOR:
Name o boin Name:JOHN M.APPLEBEE
Address: 11 co q-6— LipCompany:JAK, INC.dba APPLEBEE ELECTRIC
City: Lcc2 IVO , State:_ Address:P.,O. BOX 15
Zip Code: ' Fax: City: FT. PIERCE State: FL
Phone No. Zip Code: 34954-0015 Fax: (772)466-3765
E-Mail: Phone No (772)466-7930
Fill in fee simple Title Holder on next page(if different E-Mail APPLEBEEELECTRIC@BELLSOUTH.NET
from the Owner listed above) State or County License EC0002956
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.
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 TITLEHOLDER: _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 certlfythat 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 cohsideration 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
comawcing work or recording our Notice of Commencement.
T
ignature Owner/L'essee n ctor as Agent for Owner Si ature Contractor/License H der
STATE F FLORIDA S F FLORIDA
OF STLUCIE COUNTY OF STLUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 0m day of OCTOBER 2019 by this "H day of OCTOBER 2019 by
JOHN M.APPLESEE JOHN M.APPLEBEE
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 Q Q
(Signature of Notary Public-State of Florida) (Signature oflNotary Public-State of Florida)
Commission No. GG1269 Commission No.GG126946 .
•"4YpL MELISSA PARRAMORE ""'•• MEdSSA PARRAMOftE
:f'; W. Notary Public-StateofFlorlda ;�vpJ,�t.` Notary Public-StateofFlcdda
Commission g GG 126946 +
My Comm.Expires Jul 23,2021 •« •= Commissionr sJ 123,20
;j,` MyComm.Explres1u123,2021
acoded through National Notart sso. 'Fca 9 ry
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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