HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 03/17/2021 Permit Number:
`;'iLUGLL
L L L D 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
PROPOSED IMPROVEMENT LOCATION:
Address: 3312 NW Perimeter Rd, Palm City, FL 34990
Property Tax ID #: 4436-510-0026-000-5
Site Plan Name:
Project Name: Guba Residence
DETAILED DESCRIPTION OF WORK:
Install whole house generator. 24KW 120-240v aluminum housing.
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION:
Lot No.22
Block No.
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: $ 8,134 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Philip P Guba
Name: Kent Blosser
Address:3312 NW Perimeter Rd
Company: Blosser Electric
City: Palm City State: _
Zip Code: 34990 Fax:
Phone No.317-414-5257
Address: PO Box 7305
City: Port Saint Lucie State: FL
Zip Code: 34985 Fax:
Phone N0772-337-0055
E-Mail: philippaulguba@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Electricinc.info@gmail.com
State or County License EC13001570
it value oT construction is [Suu or more, a KtCUKDED 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:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
State
Not Applicable
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone;
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
_ Not Applicable
State:
_Not Applicable
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 you property. A Notice of Commencement must uberrded in the public records of St.
Lucie County.and pos d on the ' site before the first inspection. Iend to obtai ancing, consult
with IencJeror orneub r commencing work or recordingVce of Comr a ement.
Ily
Signat6re of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF S� UQ:e I COUNTY OF S}- U IC�Q-
Swo r to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this—VKdayof Mt71'fC�'1 26c2ca1by
k�- �k��
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida 1
��4 •. ALISON HANSON
Commission No. =AAYCOMMIi"#GG970043
EXPIRES: March 16, 2024
Sv n to (or affirmed) and subscribed before me of
VV Physical Presence or Online Notarization
this A day of MGiiICk/ , 2626 by
1�&� ?Nye acv)
Name of person making statement. /
Personally Known •✓ OR Produced Identification
Type of Identification
Produced It
/�� - ZAn
(Signature of Notary Publi
• ALISON HANSON
:• MYM SION # GG 970043
Commission No. = <; March 16, 2024
Bonded Thru Notary Public Underwrltei
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED