HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '(�- Ul�
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Date: Permit Number: W
—� RECEIVED
Building Permit Application
U 1020
Planning and Development Services MAR
Buildingand Code Regulation Division set St t`n�9 o county nt
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT TYPE: Temporary Pole Permit
PROPOSED;IM'PROVEMENT-LOCATION 4
Address: 5008 WATERSONG WAY
Property Tax ID #: 253250000800009 Lot No. 66
Site Plan Name: Block No.
Project Name: Hernandez Residence
DETAILED DESCRIPTION OF WORKc
Install temporary electric pole
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 500.00 Utilities: —Sewer —Septic
Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE
_CONTRACTOR _
Name Wendy L Hernandez
Name: John Cavnar
Address: 1306 Windsor Station DR
Company: Goldstar Electric, Inc.
Address: 213 NE Sagamore Terrace
City: Winsor State: _
Zip Code: 06095 Fax:
City: Port Saint Lucie State: FL
Phone No.
Zip Code: 34983 Fax:
E-Mail:
Phone No 772-380-5913
E-Mailjohnc@goldstar-electric.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License EC13002082
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.
S;UPPLE(VIENTALCONSTRUCTlON LIEN LAW INF.ORMATIQN
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 JENDER_W AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Si e f O er/ Lessee/Contractor as Agent for Owner
Si t of Contractor/License Holder
S ATE OF FLORIDA �P
ATE OF FLORIDA I
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of , 20_ by
To4/u
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification`
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pro(Aced
Produced
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C�IMISSION
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"•• FOP: EXPIRES:December20, 2022
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Rev. 2/7/19