HomeMy WebLinkAboutBuilding Permit Applicatioon All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Permit Number
S57p
W V
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 FORBectrical
PROPOSED IMPROVEMENT LOCATION:
Address: 10725 S.Ocean Drive,#57,Jensen Beach,FL 34957-Holiday Out at St-Lucie BLK G Lot 18 and equal pro-rala interest in common elements
Property Tax ID#: 4511-501-0228-000-3 Lot No.18
Site Plan Name: Palazzolo Block No. G
Project Name: Palazzolo
DETAILED DESCRIPTION OF WORK: I
Remove existing Pedestal and replace with a Florida Approved 125 AmF Pedestal.
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: Sq. Ft. of Fist Floor:
Cost of Construction: $ 2,200.00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Rosemarie Palazzolo Name:James D Brown
Address:10725 S. ocean Drive, #117 Company:Jim Brown Electric, LLC
City: Jensen Beach, FL tState: Address:3352 NE Skyline Drive
Zip Code: 34957 Fax:none City: Jensen Beach State:FL
Phone No.631-335-8275 Zip Code: 34957 Fax: Ofc#772-209-0280
E-Mail:onecraftrosegomail.com Phone No 360-803-5333
Fill in fee simple Title Holder on next page(if different E-Mailidb5333@gmail.com
from the Owner listed above) State or County License
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 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 installat on 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 than I will, in all respects, perform the wcrk
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 fina-icing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Sig re of Owner/Lessee ractor as Agen or Owner i ure of Contract License Holder
— -
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Cr v— COUNTY OF yY.cz+,—�-k'E
Swor o(or affirmed)and subscribed before me of Sworn to(cr affirmed)and subscribed before me of
Physical Presence or Online Notarization __L_--Physical Presence or Online Notarization
this_fql day of r-s 202F by this�4-'-day of A ;Or. 1 202# by
r cf_ V Y
Name of person making statement. Name of person making statement.
Personally Known roduced Identific Ian Personally Known ,_----()R Pr uced Identifica.tian
Type of Id"lfication Type of Identification
Produced r I ,�_ L Produced --t3-e
(Signature of Notary Public-State of Florida ) (signature Df Notary Public-State of Florida.)
Commission No KAREN CODERRE m fission No.G Cr $ I
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EXPIRES:April 23,20 *'
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COUNTER REVIEW REVIEW REVIEW REVIEW
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DATE
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