HomeMy WebLinkAboutAppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
9r. LUC IE
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Planning and Development Services
Permit Number:
Building Permit Application
Building and Code Regulation Division
2300 Virginia avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential x
PERMIT APPLICATION FOR.
PROPOSED IMPROVEMENT LOCATION:
Address: 15001 W Angle Fid Fort Pierce, FL 34945
Property Tax ID #: 2306-221-0401-000-1
Site Pian Name:
Project Name: V iA-We Sokckf`
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit–check all that apply:
Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
_ Sprinklers
—Shutters Windows/Doors _ Pond
Generator Roof Pitch
5q. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Michael J Vitale
Name: I ChO !++
QS d
Address:15001 West Angle Road
Company: Testa Energy Operations Inc
Address: 5350 NW 35th Ter Suite 100
City, Fort Pierce State:
City: Fort Lauderdale State: FL
Zip Code: 34945 Fax:
Phone No. 7722079212
Zip Code: 33309 Fax:
E -Mail: vitaleintl@gmail.com
Phone No 54644— -
Fall in fee simple Title Holder on next page ( if different
E -Mail F" P R cc 6r JQndopiC P-k_SJR •C0M
from the Owner listed above)
State or County License F_C 1200 (o22 6
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.
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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 thepermit 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF B—am
Sworn to (or affirmed) and subscribed before me of
Physical Presence or x Online Notarization
this day of =2112020 2020 by
Michael J Male
Name of person making statement.
Personally Known OR Produced Identification x
Type of Identification
Produced Drivees Licerme
Anthony Ryan Tillman
Commission Na. Commission # GG 966853
Notary Public - State of Florida
My Commission Expires Jan 30, 2622
REVIEWScvni1vv sUrcnvtauri
COUNTER I REVIEW I REVIEW
DATE
COMI
STATE OF FLORIDA
COUNTY OF
SVrn to (or affirmed) and subscribed before me of
^ Physical Presgnce or Online Notarization
this „aay of 2020 by
Nic��LaS rl�
Name of person making statement. in
Personally Known /4 OR Produced IdentificatimpseNeIgne,.
Type of Identification ,.:.; _. state or Fkxru<.
Produced ` r Ashley N Taylor
rIAV es OW242 iSgon G 149324
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(Signature of Notary Public- State of Florida )
Commission No. ( 1_q (Seal)
REV EW NS I VREVEWON I $ REVIEW I MREV EANGWVE
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