HomeMy WebLinkAboutAPPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
NEW
Permit Number:
FJ L c� I;v IJ LD) zz ---, Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 5107 Palm DR Fort Pierce, FL 34982
Property Tax ID #: 3402-608-0329-000-1
Site Plan Name: INDIAN RIVER ESTATES -
Project Name: Raymond B Quinonez Diaz
DETAILED DESCRIPTION OF WORK:
Install solar roof mount PV system
New Electrical Meter N/ Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
XElectric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ `I l
Generator
Lot No. 27
Block No.
Windows/Doors _ Pond
Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Raymond B Quinonez Diaz
Name: Daniel Yates
Address: 5107 Palm DR FL
Company: Efficient Home Services Of Florida
City: Fort Pierce, State: _
Zip Code: 34982 Fax:
Phone No. 844-778-8810
Address: 9614 International Ct N
City: St. Petersburg State: FL
Zip Code: 32934 Fax:
Phone No 844-778-8810
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Permitting@ehsfl.com
State or County License EC13008759
It 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: Reyes Ruiz Donate
Name:
Address: 9614 International Ct N
Address:
City: St. Petresburg State: FL
City: State:
Zip: 33716 Phone 844-788-8810
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.
Signature of Owner/ Lessee/Cordractor as Agent for Owner
Signature -of Cont ctor/License Holder
STATE OF FLORI Q
1
STATE OF FLO A
COUNTY OF - % � .
COUNTY OF ( \1�1P LIS
S orn to (or affirmed) and subscribed before me of
Physical Prese ce or . Online Notarization
this � day of 2020 by
S orn to (or affirmed) and subscribed before me of
P ysical Pres nce or Online Notarization
this , day of r 2020 by
C
Name of0rson making statement.
me of person makings tement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
duce-
oduced Iq
� %
II
l
( 'gnature of Notary Pullie
�,jay rpa4 Notary Public State of Florida
Commission No. ? ; Dan�Sl 0 Rutledge
.1 •L o` My commission GG 249046
a�os t�. Expires 08/15/2022
(S"tu_r6 of Notary Public-
o41"y "4y� Notary Public Stale of Florida
ommission No. D N Rutledge
- 9e
-� >_ o MY Commission GG 249046
~�oF �O� Expires 08/15/2022
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