HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED QQ
Date: 12/16/2020 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578
!PERMIT APPLICATION FOR: Electrical Connection for Mini Split
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Address. 5365 San Benedetto PI, Fort Pierce, FL 34951
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Property Tax ID#: 1311-701-0024-000-4 Lot No. 17
Site Plan Name: Block No. 5
Project Name: Christopher Gay - Mini Split Installation
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INSTALL NEW MITSUBISHI 1 TON MINI SPLIT IN THE GARAGE. MUZ-GL 12NA-U1 MSZ-GL 12NA-U1
Reference: Permit number 2012-0110 for HVAC permit.
New Electrical Meter Second Electrical Meter
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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:
CI st of Construction: $ 500.00 Utilities: —Sewer _Septic Building Height:
Name Christopher Gay Name:Donald Green
�Address:5365 San Benedetto Place Company: Don Green Electric, LLC
City: Fort Pierce State:_ Address: 1305 W First St
li Zip Code: 34951 Fax: City: Fort Pierce State: FL
,Phone No.(321) 720-3161 Zip Code: 34982 Fax:
E-Mail:ChrisG9948@gmail.com Phone No(772) 418-5739
Fill in fee simple Title Holder on next page(if different E-Mail permits@dongreenelectric.com
from the Owner listed above) State or County License EC13007447
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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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:
lAddress: 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.
T,he 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 C ty and posted on the jobsite before the first inspec ion. If you intend to obtain financing, consult
with I nd or an attorney before commencing work or rec rdI g your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID �` STATE OF FLORIDA
iCOUNTY OF COUNTY OF
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wo n to(or affirmed)and subscribed before me of .worn to(or affirmed)and subscribed before me of
Physical Pr Bence or Online Notarization V Physical Pres nce or Online Notarization
this 1"I day ofk)"_Q a 2020 by this -1- _day of AJ.o,c.. 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
Ty of Identification Typ of Identification
P odd ed r ced
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(S n ure ofotyy rt HMING ignature of Notatq P ic-�ittAlofAPl §I)ZgHMING
t ti ,: %ly COMMISSION#GG 275060 6 Aay C0MMl8510N#GG 275060
ommission Nv j FxytRFS:Decem�W) 022 Commission No ,,;'c L'�Nil'ES:Decem��@�1�022
Bonded Thru Notary Public Underwriters `__ ud•:d 7hru Notary public Underwriters
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 6