HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
0
9? - � o 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: GRINDER PUMP
PROPOSED IMPROVEMENT LOCATION:
Address: 1402 HARTMAN RD
Property Tax ID #: 2417-233-0002-010-9 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
ELECTRICAL INSTALLATION OF CITY SEWER GRINDER PUMP
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
��, Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction. $ 843
Sq. Ft. of First Floor:
Utilities: '�_ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Daniel P Retherford
Name:PAULROMANO
Address:1402 HARTMAN RD
Company:AAPEX ELECTRIC
City: ST LUCIE COUNTY State: _
Zip Code: 34997 Fax:
Phone No. 772-224-9826
Address:561 SW BILTMOORE ST
City: PORT ST LUCIE State: FL
Zip Code: 34983 Fax:
Phone No7726079494
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailAAPEXELECTRIC@YAHOO.COM
State or County License 13009343
IT value or consIrucTion Is LbUU or more, a KLCUKULU 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
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:
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 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 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.
Sr nature o Ow er/ Lessee ontractor as'Agearfor Owner
Signature of Contractor/License Holder
STATE OF FLORIDA _v
COUNTY OF , L( 4:C.i
STATE OF FLORIDA,-- .
COUNTY OF ,
S n to (or affirmed) and subscribed before me of
Sw99rn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 4.? day of a9l'_ L 202* by
V Phys cal,.Presence or Online Notarization
this — day of i i�iu`G 202� by
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Name of person making statement.
Name of person making statement.
P nally Know OR Produced Identification
_.P.Prsonal(y. Known-- /--) OR Produced Identification
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Type of Identification
Pro'duced
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