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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l 9 Permit Number:
• . ®
Building Permit Applicatiort, ee �o
Planning and Development Services
Building and Code Regulation Division
9
2300 Virginia Avenue,Fort Pierce FL 34982 e c �Pry�
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: Electrical
'PROPOSED IMPROVEMENT LOCATION,-
Address: 9400 S. Ocean ,Drive., Unit #208, Jensen Beach, FL 34957
Property Tax ID#: 3535-702-0015-000-5 Lot No.
Site Plan Name: Block No.
Project Name: Donal Harris
i
.DETAILED DESCRIPTION OF WORK
Remodel kitchen lighting (i.e. remove existing and replace with 8 LED light ,fixtu'res) ,
disconnect old electric water heater and reconnect new electric water heater, remodel
in master bath (i.e;' add circuitry to accommodate whirlpool tub, relocate witching for
_._
removeiptin li ht fixtures and replace with LED light fixture
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
X Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: . Sq. Ft.of First Floor:
Cost of Construction:$ 2,400.00 Utilities: —Sewer —Septic _Building Height:
01NNER/LESS,EE .CONTRACTOR:
Name DonsI d .T_ HAr'ri G Name: Michael Dale Ault
Address: 6380 S. Dixie Hwy Company: Ault Bbos. :Inc. Electrical Contract
City: South Miami State: FL Address: PO Box 1528
Zip Code: 33143 Fax: City: Port Salerno State: FL
Phone No. Zip Code: 34992 Fax: N/A
E-Mail: Phone No 772-283-5520
Fill in fee simple Title Holder on next page(if different E-Mail aultbros@yahoo.com
from the Owner listed abi ve) State or County License E00001693
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 CQNSTRUCTfON LIE
N LAW INFORMATION
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 LENDER OR AN ATTORNEY B ORE RECORDING YOUR NOTICE OF COMMENCEMENT."
_VM L1�v"'—''- (� 4 �� �__
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this, day of 20/a�. by th� ay ofj/L 2V.7 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification a/
Type of(dengJ iication Type of Iden ' ication Q
Produced Produced ZZ,r�'✓�/� �(J C cn�f-2_
Signatur x*Ne Signature of Notary Public-State of Florida)
SUSAN RUTH DESALVE
Commissionc*1 Notary Public,State o(SaMh Commiss n SUSAN RUTH DESALI(Beal
Commission#GG 907104 c~ l oc Notary Public,State of Florida
^l>' tdv comm.ex fires Au .25 2023 " Commission#GG 90710
My com .expires Aug.25,2023
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