HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO//M--UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED JD
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Date: fl� C� Permit Number:
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.....,.....�_ __. - ,,... ,,tl, ,_� Building Permit AppliPlanning and Development Services
Building and Code Regulation Division m e n t2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial , FL
PERMIT TYPE:Electric
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Address: 2102 Nettles Blvd Jensen Beach, FL 34957
Property Tax ID#: 4502-501-0105-000-7 Lot No.
Site Plan Name: Block No.
Project Name: Perhach
Install 120V 20Amp Dedicated GFCI Circuit
Additional work to be performed under this permit–check all that apply:
_Me anical _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:
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NameAndrew J Perhach Name:Anthony Stumpp
Address:2102 NETTLES BLVD Company:Millennium Contracting Services Inc
City: Jensen Beach, State:_ Address:9045 SE Hobe ridge Rd
Zip Code: 34957 Fax: City: Hobe Sound State:FL
Phone No.772-229-3022 Zip Code: 33455 Fax:
E-Mail:N/A Phone No561-718-9422
Fill in fee simple Title Holder on next page(if different E-Mail mcsielectric@bellsouth.net
from the Owner listed above) State or County License EC13001885
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.
W111005/1'
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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEND ATTORNEY BEFORE RECORDING YOUR NOTICE OFCOMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for OwnerSignature C ntractor/License Ffolder
STATE OF FLSTATE OF FLORTdZ0 VJ
COUNTYOF _ COUNTY OF
The forgoing instrument was acknowledged-before me The f r i g instr m nwa�acknowledge efore me
this day of 20by this Way of V 20by
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Name of person making statement. Name of persona ing statement.
Personally Know Produced Identification Personal/ wn R Produced Identification
Type of Ide ' icatio Type o dentification
Produced j Prod ed
(Signatu e ot112ry ub c� �of �i (Signa a ota date Rt&y�i )sfate of Florida
o ary blic State of Florida '4,HRYN POCKER KATHRYN POCKER
Commissio %� any�6�1)3sion GG 048422 Commission No. r; ... Q �v commeBG 0ee422
osw Expires 11/21/2020 Orry Expires 1112,1120 2 0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19