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Date: oC ' T a I Permit Number:
n
O
Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Service Change/ FPL Transformer Relocate
PROPOSED IMPROVEMENT LOCATION:
Address: 5090 Dunn Road
Property Tax ID #: 3403 502 0194 000 3
Site Plan Name: Hospice House
Project Name: FPL Transformer Relocate
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Rework underground service from existing FPL transformer to new FPL transformer location. Service size is the same.
Total scope of work is to rework service due to FPL transformer relocation.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical
A Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 313848.00
_Gas Piping _Shutters
_Windows/Doors _Pond
_Sprinklers _Generator _Roof Pitch
Sq, Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameTreasure Coast Hospice
Name:Thomas E. Granims
Address:5090 Dunn Rd
Company: Paragon Electricof Vero, Inc.
City: Ft. Pierce State: _
Zip Code: 34981 Fax:
Phone No, 772 807 6487
Address:9120 16th Place
City: Vero Beach, State: FI
Zip Code: 32966 Fax: 772 299 5167
Phone N0772 569 8961
E-Mail:dingraham@treasurecoasthealth.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail paragonelectric@bellsouth.net
State or County License EC0002731
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: Not Applicable
Name:
MORTGAGE COMPANY: NotApplicahle
Name:
Address:
Address:
City: State:_
City: State:_
Zip: Phone
Zip: Phone:
FEE.SIMPLETITLEHOLDER: I/NotApplicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
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.certifythat no work orinstallation 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 withanyapplicable 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 grantingof 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 our Notice of Commencement.
Signature of Owner/lessee/Contractor as Agent for Owner
Signature ofConttactor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA I . , _ 1% ►7`
COUNTY OF I Ala/\ KllrtW4�
Swam to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _ day of 2020 by
Sworn to (or affirmed) and sub;etibed before me of
P -sical Presence or V online. Notarization
this�i day of Foeb .2020 by
-Thous C-roran=�nnS
Name of person making statement.
Name of person making statement.
Personally Known. OR Produced identification
Type of Identification
Personally Known OR Produced Identification
Type of Identification
Produced
Produced
Qo'��ec GG
(Signature of Notary Public- State of Florida)
(Signaturf of Notary Buhlic-State of Flor'- �
Commission No. (Seal)
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Commission Nol�l_�..J�''� ��,P
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
5EATURTL
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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