HomeMy WebLinkAboutbuilding permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION 1'0 BE ACCEPTED
Date:
- j
s
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349,92
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commerci<3I . Residential X
EPRO-P:0:SED
TYPE:Electrical IMPROVEMENT LOCATION:
Address: 10701 S. Ocean Drive, Lot ##627, Jensen Beach, FL 34957
Property Tax ID #: 4511-805-0028-000-4
Site Plan Name:
Project Name: Worsnop
DETAILED DESCRIPTION OF WORK:
Provide and install new pedestal (service change)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
—Mechanical — Gas Tank Gas Piping — p g —Shutters
Electric — Plumbing —Sprinklers ` Generator
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 1,700.00
Utilities. —Sewer —Septic
OWNER/LESSEE:
Name David & Lois Worsnop
Address:10701 S. Ocean Drive, Unit #634
City: Jensen Beach
34957 State:
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Lot No.
Block No.
— Windows/Doors
— Roof Pitch
Building Height: —
CONTRACTOR:
Name: Michael Dale Ault
Company:Ault Bros, Inc. Electrical Contractor
Address:PO Box 1528
City: Port Salerno
State: FL
Zip Code: 34992 Fax: None
Phone lJo 772-283-5520
E-Mail auitbros@yahoo.com
State or County License ECO001693
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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: _ State:
Zip: — Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:_
Zip: Phone:
Zip: _ Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to otlain 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 anti 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 1 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 IOUR NOTICE OF COMMENCEMENT °i
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �kul
The fZoing instrLMas acknowledged before me
this a of 2geoby
Name of person making statement.
Personally Known OR Produced Identification
Type of Iden l ati n
Produced
164Y , ��XAWIA---
(Signature of Notary Public -
Commission No.
)ri(Mt�ry Public State of Floridi
Diana L Mason
i mmission GG 316460
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REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
[SATE
COMPLETED
A Vp a I (ts ' J/
Signature of Contr for/Lic se o der
STATE. OF FLORIDA
COUNTY OF ji 4
The f going instru a acknowledged before me
this day of 245�y
i
Name of person making statement.
Personally Known OR Produced Identification
Type of Identifi n
Produced
011 ilwd
I'nature of Notary Public- State +P ..�Notary Public Stateof
_Diana L Mason
mission No. ': Commission GG 3
maw ExpiresD3126l2023
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