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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: 11/12/19 Permit Number: 1
y- � 4 " RECEIVED
• 'NOV.18 2019
Building Permit Application
Planning and Development 5ervices Permitting Department
Building and Code Regulation.Division 6t, 1,40 P.fognty
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Electrical
PROP®SEDIMPROVEMENT -T IN
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Address: 901 33rd Fort Pierce, FL 34982
Legal Description: 17 35 40 BEG AT INT OF W R/W S 33 ST AND N RM OF DEBERRY RD,TH RUN N ON W
Property Tax ID#: 2417-211-0007-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
,DETAILED DESCRIPTION QF WORK
Change Overhead Service to Underground Service
�I
,CChWW71C ICN INFORMATION
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Additional work to be pertorme under this permit–c ec all appy:
HVAC Gas-Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑✓—Electric 0 Plumbing Sprinklers a Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: 2176 S1500.00 Ft. of First Floor: 2176
Cost of Construction:$ Utilities: _Sewer E]Septic Building Height:
01NNERjLESSEEfi,xNTRACTR .
� O ,.
Name C A Borland Name: Ger rd thelusca
Address:901 S 33rd ST Company: S 7-� / z 6:-c %A /
City: Fort Pierce State:FL Address: 1311 Fairfax Circle
Zip Code: 34947 Fax: City: Boynton Beach State:FL
Phone No. Zip Code: 33461 Fax: 772-907-0420 j
E-Mail: Phone No. 772-203-4202
Fill in fee simple Title Holder on next page(if different E-Mail: rodwallerl@gmail.com
from the Owner listed above) State or County License: EC13006942
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
St1PPL'EMENTAL CONSTfUCTION LIEN LAW INF,ORIVIATION~
DESIGNER/ENGINEER: Q Not ApplicableMORTGAGE COMPANY:
Q Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 0 Not Applicable BONDING COMPANY: allot 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
/X. 9, 4to-4—r —
Signature of Owner/Lessee Contractor as Agent for Owner Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie County COUNTY OF St Lucie County
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 12th day of November 20 19 by this 12th day of November 20 19 by
Gerard Thelusca Gerard Thelusca
Name of person making statement Name of erson makin statement
Personally Known x Personally Known o i
Type of Identification •iy terry Public Stets a Ftodds Type of Identifica o Notary Public State a Fbrido
Produced Produced My Co Harris
Sophia Hems � Commission GG 236873
mission GG 236873 Expires 05x=020
+�M x ros 05l30r1020
All—
(Signature ANotary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17