HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7/22/2020 Permit Number:
917o UWE
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Install EV Cal" Chargers
PROPOSED IMPROVEMENT LOCATION:
Address: 6501 S. Ocean Drive Jensen Beach, FL 34957
Property Tax ID #: 3508-111-0002-000-3 Lot No.
Site Plan Name: Block No.
Project Name: St Lucie Workplace Gate C EV chargers
DETAILED DESCRIPTION OF WORK:
Install electric vehicle car chargers
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 _ Windows/Doors _ Pond
JElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 32683 Utilities: —Sewer —Septic Building Height: _
OWNER/LESSEE: CONTRACTOR:
Name Florida Power and Light Company
Name: Brett L Ernes
Address: 700 Universe Blvd PSX/JB
Company: SEM Power LLC
City: Juno Beach State: _
Address: 4466 Eagle Falls PI.
City: Tampa State. FL
Zip Code: 33408 Fax:
Phone No. �, qoq - C(, 70
Zip Code: 33619 Fax:
E-Mail: &)wrrc(CP FPL- C-C),r.
Phone No 888-496-1119
Fill in fee simple Title Holder on next page ( if different
E-Mail richard@sempower.net
State or County License EC13007428
from the Owner listed above)
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 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 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.
'�\ I - I(J�Yw l
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO A Q I I^
STATE OF FLORIQA
-
COUNTY OF G A�C�' ,
COUNTY OF 6
Swot to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
Sw�of n to or affirmed) and subscribed before me of
Pre nce or Online Notarization
this ay of 2020 by
of t,� 2020 by
�(
aIkaay
i'
Name of person maVstatement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
M A
(Signature titary PubIi4A �ge of�ddh ¢hapman
(Signatu465frye,A, c- SKAteietElaidW KAHMANN
;Notary Public -State of Florida
No. Commissioga, 360550
ro soy, NOTARY PUBLIC
Commission Comm i Expires
Co sion No. STATE(9e"]LORIDA
76. g
September 18, 2023
" r Comm# GG201675
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