HomeMy WebLinkAboutBUILDING pERMIT APPLICATION/DRAWINGAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 02/04/21 Permit Number:
11 a
. � ! 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:SeI"VICe
l PROPOSED IMPROVEMENT LOCATION: same location
Address: 2756 BROCKSMITH RD
Property Tax ID ti: 2320-501-0060-000-5
Site Plan Name:
Project Name: RICH SAMPSON- BROCKSMITH
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
X
Lot No.8
Block No. 4
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 2000.00
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Richard A Sampson
Name:MATTHEW RAULERSON
Address:2756 BROCKSMITH RD
Company:THE ELECTRICAL EXPERTS LLC
City: FORT PIERCE State: _
Zip Code: 34945 Fax:772-210-5928
Phone No.772-210-6100
Address:7990 SW JACK JAMES DRIVE
City: STUART State: FL
Zip Code: 34997 Fax: 772-210-5928
Phone No772-210-6100
E-Mail:MRAULERSON@THEEXPERTS.BIZ
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailMRAULERSON@THEEXPERTS.BIZ
State or County LicenseEC13008438
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: of 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: Vflot Applicable
Name: Name: r(
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
which is in conflict with any applicable Home Owners Association rules, bylaws or angcovenants 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 roams 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 lend ran attoul'e'v before commencing work or recording our Notic of Commencement.
3
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Signature of Owner/ Le., a/Contractor as Agent for Owney
Signature of Contract/License Holder
STATE OF F�ORID,pt
STATE OF FLQRIDS
COUNTY O MARTIN
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Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
x Physical Presence or Online Notarization
this a day of FEBRURARY 12020 by
this _ day Of FEBRURARY , 2020 by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification x
Personally Known OR Produced Identification x
Type of Identification
Type of Identification
Produucce(d DRIVERS LICENSE
Produced DRIVERS LICENSE
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(Signatureof-Notary Public- State of Florida)
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