HomeMy WebLinkAboutBuilding Permit Application Jan.06.2021 02 :26 PM DuBois Electric MD Corp 7727771846 PAGE. 2/ 7
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ' 0 �'
Date: 01/06/2021 Permit Nu
JAN 3 2021
Building Permit Applic tliamitting Department
Planning and Development Services St. Lucie Countyr FL
Building and Code Regulation Division Commercial
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Steve Foor
PROPOSED IMPROVEMENT LOCATION:
Address: 13328 NW Eleyyood Place, Palm City, FL 34990
Property Tax ID#: 4425-703-0038-000-0 Lot No. 33
Site Plan Name: _ Block No.
Project Name: Foor
[RETAILED DESCRIPTION OF WORK:
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
le Electric —Plumbing —Sprinklers _Generator �Roof �Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 630.00 Utilities: -Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name: Daniel DuBois
Address: Company: DuBois Electric MD Corp
City: _ State: Address: 3981 SE Dixie Ross Street
Zip Code: Fax: City: Stuart State. FL
Phone No. Zip code: 34997 Fax:
E-Mail: Phone No. (772) 287-5539
Fill in fee simple Title Holder on next page(If different E-Mail duboiselectricmd@gmail.com
from the Owner listed above) state or County License EC13007817
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,
Jan.06.2021 02:27 PM DuBois Electric MD Corp 7727771846 PAGE. 3/ 7
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/EN6INEER: -Not Applicable MORTGAGE COMPANY: —4ot 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 ermit holder to build the subject structure
structture.Pleasefl consult w thpyour Nome Owners Associattion and review your deedn�or any restsrictions which may prohibit such
V 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 attornev before commencina work or recording our Notice of Commencement.
Si nature of n Le e o tractor as Agent for Qwner> S4 nature of 6ni(actor/kIcense Holder
STATE OF FLORIDA STATE OF FLO IDA
COUNTY OF YYIw Lo COUNTY C ly� ,
Sworn to(or affirmed)and subscribed before me of Sworn o(or affirmed)and subscribed before me of
tcal Presence or online Notarization Ph slcal Presence or Online Notarization
this 2j�±day of JSL- )EL 2020 by this ay of MEP O-EC�� 2020 by
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Name of person making statement. Name of person making statement. I
Personally Known-.OR Produced Identification ✓ Personally Known_OR Produced Identification 1/
Type of Identification Type of ld fi ti n
Produced: Pro uced
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DATE
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DATE
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