HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ O� b `ait Permit Number:a`
o (U�
RECEIVED
Building Permit Application
Planning and Development Services OCT 3 0112020
Building and Code Regulation Division Commercial ReSidentia6rNtting Department
2300 Virginia Avenue, Fort Pierce FL 34982 t. Lucle.uounty
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Service Change
PROPOSED] MPROVEM ENT LOCATION: -
Address: 5205 Indian Bend Lane
Property Tax ID #: 1312-800-0025-000-8 Lot No. 194
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: -
Change existing 200 amp panel and meter can
New Electrical Meter I/ 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
, Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total) Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / 5�20'w Utilities: _Sewer —Septic
Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name Susan L Spengler
Name: John Cavnar
Address: 5205
Company: Goldstar Electric, Inc.
City. Fort Pierce State: _
Address: 213 NE Sagamore Terr
Zip Code: 34951 Fax:
City: Port Saint Lucie State: FL
Phone No.
Zip Code: 34953 Fax:
E-Mail:
Phone No 772-380-5913
Fill in fee simple Title Holder on next page ( if different
E-Mailjohnc@goldstar-electric.com
from the Owner listed above)
State or County License 23575
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.
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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 yo • tend to obtain financing, consult
wio lend r o attorney before commencing work orrrec_grdingyo N tice of Commencement.
20ature caner/ Lessee/Contractor as Agent for Owner
i nature of Contractor/License Holder
STATE OF FLOPIDA
STATE OF FLORIDA
COUNTY OF 5k -
COUNTY OF Sk. Lac e
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presencq or Online Notarization
this7.0 day of ac--V 2020 by
this day of ac,2020 by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
f
Type of Identi cation
Produced '� L, L
Produced L- L_
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(Signature of NotaN Pu - e,o on 4 _
NA (Signature of Not u
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MY COMMISSION # GG 022023 ti?0 p
Commission No.�•G ;Q-ir E( :pecemberlB;z020 a• S� IEGIVEIVS
Commission No. U
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':;FOF Flo?•' Bonded Thru Notary Public Undarwrlters IR # GG 022023
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REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATION SEA TURTLE MANG
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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