HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT TYPE: ELECTRICAL
PROPOSED IMPROVEMENT LOCATION:
Address: 9940 S OCEAN DR UNIT 910, JENSEN BEACH, FI 34957
Property Tax ID #: 4502-502-0097-000--0 Lot No
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
ef1ace EX,Cir" ,
�r-lynb 4.aleD �:,5 Arne c.IrLe",.k GTz- ns4 v
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: $ 150o
5v o Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MOANA MANAGEMENT
Address:3 PALMETTO OR
Name- JOHN M CAVNA
Company:GOLDSTAR ELECTRIC
City: STUART, FLORIDA State:
Address: 213 NE Saaamore Terrace
Zip Code: 34996 Fax:
City: Port Saint Lucie State. FL
Phone No. 954-553-1778
Zip Code: 34983 Fax:
Phone No 772-380-5913
E -Mail: robyn.batson(fgmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail johncQgoldstar-electric.com
State or County License 23575
If value of construction is $ 5W or more, a RECORDEo rtouce of commencenmm a required.
If value of 14VAC is 57,E or more, a WORDED Notice of commencement Is required,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable
MORTGAGE COMPANY:Nat 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 authorise the /mit holds to build the subjectructure
which is in conflict with any applicable Home Owners AsWistion rules, bylaws 4r ane 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
0"ARN W TO OIM M YOUR FARM TO RECORD A NOTICE OF MAY RESULT N YOUR PATH
TAKE FOR TO YOUR PROPY. A NOTICE OF MUST BE RECORDED AND
POSTED ON THE JOB SIZE BEFORE TW FiR3fi ONSPECMN. IF YOUTO OBTAM MUkNE>MG, CONSULT
r1►M YOUR MOM OR AN ATI'ORiMEY BEFORE N6COIB1BiGal°OUR,ilf�lg��AMgEUWCEME�•"
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Signature of essee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The ing Instrumint was acknowledged before me
ay of °i 20 '?=' by
d�A' c O'.
Name of persorijmaking statement.
Personally Known #-'OR Produced Identification
Type of identification
Produced
(Signature of Notary Public
!Y n Nctaary public Stats? of Florid;
Commission No. Galvin
J� y Commission GG I NEB'
Expires 03/2112022
STATE OF FLOR
COUNTY OF_ ±
The forgoing instrument was acknowledged before me
thisday of (Y AFS C'_ 1-t_ zO�Crby
C V .
Na of person ma nLaatement.
Personally Known OR Produced identification
Type of Identification
of Notary Public- State of Florida j
l.f:EN ltpiilA
REVIEWS I COUNTER REVIEW SUPERVISOR REVIEWI REVIEW VREVIEWaN REVIEW I REVIEW
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