HomeMy WebLinkAboutMary Anne Palino permit appAll APPLICABLEr1FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: GI ddZb Permit Number:
os
Building Permit Application
Planning and Development Services
Building and Code Regulation [Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 8430 Hidden Pines Rd- Ft. Pierce
Property Tax ID #: 2323-701-0007-000-9
Site Plan Name:
Project Name: Mary Anne Palino Residence
Residential xxx
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: Not--]
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
w Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $L%
Generator
Sq. Ft. of First Floor:
-Windows/Doors _ Pond
Roof Pitch
Utilities: Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Mary Anne Palino
Name: David A. Birth
Address:8430 Hidden Pines Rd
Company: Camouflage Electric Inc.
City: Ft. Pierce State: _
Zip Code: 34947 Fax:
Phone No.
Address;460 NW Concourse Place Ste 11
City: Pt St Lucie State: FL
Zip Code: 34986 Fax: 772-340-0560
Phone No772-340-0111
E-Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E-Ma-1IDavidbcei@outlook.com
State or County License EC13001924
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAVA 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
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 guild 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature Owner/ L ee/Contractor as Agent for Owner
Sign of Contra r icense Holder
STATE OF FLORIDA
COUNTY OF �, L �� + C.
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
P�hysical Presence or Online Notarization
��`
this day of 2020 by
I'
Swor�.to (or affirmed) and subscribed before me of
✓Physical Presence or Online Notarization
thisl It day of 2020 by
Dav i (i a. , +w
�1-
ment.
Name of person mak7013
Pers pally Known Produced Identification
Name of person making statement.
Personally Known V OR Produced Identification
Typ of Identification
Type of Identification
Pra uced
Pr uced
Notary P
VALENTINO PEREJAssn.
VALENTINO PEREZ
-a° LAf '
i y- * �bf FCtwidd*ion # GG 06{Slgna
My Comm. Expires Apr
(SI aturJNo.
Commissi'�f+ "' Bonded(ttfeabp Nahonal NotCommission
a
ure of Nota u iEl t InrQ���nissian # GG 062155
9�: My Comm. Ex ires Apr 3, 2021
No. '�` Bonde($Igg@h Naliorlal Naiary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.