HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 C) )0 A � Permit Number:
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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: 3175 Columbrina Circle
Property Tax ID#: 3425-702-0021-000-3 Lot No.
Site Plan Name: Block No.
Project Name: Day
DETAILED DESCRIPTION OF WORK:
Like for like 200 amp pedestal change with updated grounding system.
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 First Floor:
Cost of Construction:$ 1700 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Robert C Day Name:Anthony Diodato
Address:3175 Columbrina Circle Company:Stott Brothers Electric
City: Port St Lucie State:_ Address:385 NE Glentry Avenue
Zip Code: 34983 Fax: City: Port St Lucie State:FL
Phone No.203-417-833 Zip Code: 34983 Fax:
E-Mail: Phone No 772-408-4911
Fill in fee simple Title Holder on next page(if different E-Mail stottbrotherselectric@gmail.com
from the Owner listed above) State or County License EC13007910
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.
?i . l if1 ' °'L flP�IS�RkiG7'f i lE CA INPORMAWW
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: TNot 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 a 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 1 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 a—Morney before commencing work or re oLclWg your oti ommencement.
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Signs ure of Owner/ tra or as Agent for Owner Signature of Contra / . se Holder
STATE OF FLIDRIDA STATE OF FLORIDA J
COUNTY OF l f.1 r i � COUNTY OF � jj —lid-e-
Sw rn to(or affirmed)and subscribed before me of 5 orn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization
,Physica(Presence or Online Notarization
this day of0'b�y this-9,9 day of � Y2 by
Name of person making atement. ��— Name of person making stdement.
Personally Known .� OR Produced identification Personally Known X OR Produced Identification
Type of identification Type of idenf-,cation
Produced—(—,f (2, A C C-4)`� Produced 1 ice, � ;t��P
(Signature of Notary Pu Ho 41hNNASTiLLWELL IR Signature of Notary Public-
;,; MY OMMISSION#GG 1976i59 i _ �"
Commission No. 1 SAVANNA STILLWELL
O <.... :
!o: �S:March 19,2022 � mmission No. fP *. *MISSION#GG 1976 9
Bonded Thr.Notary Public fterwriter X� EXPIRES:March 19,2022
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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