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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0-V - f1�,Z���•
RECEIVED
Building Permit Application APR 2 2 20.20
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 349B2 St• Lucie Counts
Phone:(772)462-1553 Fax:(772)462-1578 Commercial X Residential
PERMITTYPE: Temp electric
Address: 5105 Armina Place
Property Tax ID#: 131170001740007 Lot No.30
Site Plan Name: Waterstone Block No. 3
Project Name• Waterstone Phase One
. ='.DETAILED DESCRIPTION OF.INORK'� � �� r __
Install temporary electric on 20'x8'portable steel box construction trailer
"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: 160 Sq.Ft.of First Floor: 160
Cost of Construction:$ 500 Utilities: _Sewer _Septic Building Height: "-10'
`OWNE4R/LESSEE _ � _ � , CONTRACTOR s .{
Name Kevin Borkenhagen Name: Randy Siaardema
Address:3601 Quantum Blvd Company;RJS Electric Inc(DBIA)Electric connection•
C,{y; Boynton Beach State:_ Address: 1100 Barnett or#4
Zip Code: 33426 Fax: City: Lake Worth State:R
Phone No.561-364-3316 Zip Code: 33461 Fax: 561-586-9889
E-Mail:kevinmwirth@gmail.com Phone No 561-586-6499
Fill in fee simple T"dle Holder on next page(if different E-Mail bob.bromelow@electricconneedon.net
from the Owner listed above) State or County License EC0002938
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. Term , A-3
nol ' • C 0m.
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SUPPLEMENTAL CONSTRUCTION LIEN 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 SI BEFORE THE FIRST INSPECTION.IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER O AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCE
Signature of O her/L e/Contractor as Agent for Owner Signature of ntract r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PAIMe>Anci
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 18TH day of FEBRUARY 20 20 by this 7 day of April 2020 by
KEVIN BORKENHAGEN Randy Sjaardema
Name of person making statement. Name of person making statement.
Personally Known X OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced Pik
(Signature of Notary Publi18 HIM
c- � 4'� ori a �vnerl+ (Signature of Notary Public-State Notary public-State o F rich
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HUMPublic•State of Florida h tip"
4tIEic c•6 917671 GG263711 n a- Commission#GG 2 3 t
Commission No. GG 817671 ` lay ftf&Ptres Cep 29 2023 Commission No. ,or FN ea'l)Comm.Expires Oct 17 1022
BmCed ttueugh Nattaral Nct rydsm. Bonded through National No ar Vssm.
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DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19