HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7/14/2020
Permit Number:
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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 xxx
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 5924 Alexandria Circle
Property Tax I D #: 3410-503-0256-000-1
Site Plan Name:
Project Name: Gotsens Residence
DETAILED DESCRIPTION OF WORK:
Installing surger protecion and new grounding system
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit– check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing — Sprinklers _ Generator
Lot No.
Block No.
_ Windows/Doors Pond
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1173.00 Utilities: —Sewer —Septic Building Height:
— Roof Pitch
OWN ER/LESSEE:
CONTRACTOR:
NameJoseph A Gotsens
Name: George Hand
Address:5924 Alexandria Circle
Company: My Electrician, Inc.
City: Fort Pierce State: _
Zip Code: 34982 Fax:
Phone No. 772-468-2102
Address: 750 NW Enterprise Drive
City: Port St Lucie State:fl
Zip Code: 34986 Fax:
Phone No 772-283-7529
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If wthip of rnnctri+inn ie 7rnn ..
E -Mail Ldiodato@mirandacompanies.com
State or County License EC13003398
-- - - -- -. ..._._, w u= v v 1111mncement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: ""-
Address:
City: State:
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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOVICE OF CQMMENCEME�IYT."
r
of Owner essee/Contractor -as for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20_ by
Name of person ma in state
Personally Known OR Produced Identification
Type of Identification
Produced
Nicole MclMe
Gqml(Signature of �NotaryPublic �G
ri ker- OY. ,
Commission No.%d=�� ��"n! Thal Aso 11
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
COMPLETED
re of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20by
Name of person mak ng statement.
Personally Known OR Produced Identification
Type of Identification
Produced
Nicole I
COnm. t
(Signature of Notary Public- State P rTb1N
I
Commission No. G1 (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW