HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5-14-2020 Permit Number: v
0
D _
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 Residential xxxx
PERMITTYPE: Electrical
PROP OSEDaIVIPROVEMENT LQ_CATION,..
Address: 5319 Ebbtide Way, Fort Pierce, FL 34949
Property Tax ID#: 1410-502-0066-000-3 Lot No. 66
Site Plan Name: Block No.
Project Name:
'DETAILED DESCRIPTION OF WORK
Replace rusted out meter pedastel
CONSTE,VC, N INFORMATION:
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 550.00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE f CONTRACTOR
:._ a. _.
Name Mary Dombro Name: Tab Lewis
Address: 5319 Ebbtide Way Company: Cast Electric Inc.
City: Fort Pierce State: Address: 731 Carriage Lake Way
Zip Code: 34949 Fax: City: Vero Beach State. FL
Phone No. 586-873-1627 Zip Code: 32968 Fax: 772-569-9775
E-Mail: Phone No 772-569-9775
Fill in fee simple Title Holder on next page(if different E-Mail castelectric@gmail.com
from the Owner listed above) State or County License EC0002239
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.
SUPPL EMENTAL 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S+ ,I_\A C_ I �, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L�L day of 1 20_ by this �)_day of M ot ♦ 2OGUO by
Tc_xV) Lew l .s I;h Lew ^i --)
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
Produced Produced
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62�b alll� 0 L Z,7�_M _
(Signature o M o Z a Ey,r u (Signature o �} ..........
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s►aYpuaG LUANN O'CONNOR `_; •` Notary Public-State of Florida
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••` Notary Public-State i6eoi)da Commission o;�`�'o? Commission N GG 27(��1®aI)
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ommission#GG 270518 yCOMM.Expires Oct 13,2022
My Comm.Expires Oct 23,2022
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