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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED LL II _
Date: Permit Number:A l Q 'C ' 04�5
p -N Qav ``V" 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:Coastal Electrical Service
RRQPOSED IMPR01iEMENT LQCATtQN
Ye .� _i?,f t>3 n _ .EPA.t <� ` _5.�, y w�'"•
Address: 9431 Ocean Dr Jensen Beach FI 34957
Property
. 3535-334-0001-000-5 Lot No.
P Y Tax ID#.
Site Plan Name: Island Village Block No.
Project Name: Island Village
DETAILED DESCRIPTIONAF WORK
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Service change as per electrical drawing
New Electrical Meter Second Electrical Meter
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CONSTR�ICTIQNI�IFOR11/IATI�N � � � � `
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:$ 8500.00 Utilities: —Sewer —Septic Building Height:
tWNERjLESEE�`' z " ° e g CONTRFA`CTOR , A
Name Coastal Electrical Service IncMalter Runge Name:Walter Runge
Address:2155 SW Gull Harbor Lane Company:Coastal Electrical Service Inc
City: Palm City State:_ Address:2155 SW Gull Harbor Lane
Zip Code: 34990 Fax:772 286 5766 City: Palm City State:FL
Phone No.772 286 5771 Zip Code: 34990 Fax: 772 286 5766
E-Mail:ichard@coastalelectricalservice.com Phone N0772 286 5771
Fill in fee simple Title Holder on next page(if different E-Mail richard@coastalelectricalservice.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.
S..UPPLEMENTAL CONSTRsUCTION LIEN LAW INFt3RMATI�Nry
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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
improvemerlts to your prop rty. A Notice of Commencement must be recorded in the public records of St.
Lucie Coun and poste the jobsite before the first inspecti . If you intend to obtain financing, consult
with ncl r or an att n before commencingwork or record' our Not' a of Commencement.
Signature of Own, Lessee/Contractor as Agent for Owner Sigfiature of Contractor/License Holder
STATE OF FL RIDA STATE OF FLORIDA
COUNTY OF S , , �o COUNTY OFQ
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical PreseW or, Online Notarization
this 1,5 day of Q�y.0 2026-by this_IF_day of 202f by
Name of person making stag me Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification - Type of Identification
Produced Produced
( ignature of Notary Public-8t9te of —u (Signature of Notary Public- to of Florida)
Commission N ,••''� ~''•- 02T5060 Commissio : '"'�P''•• INGRAM• Nr
s EWRM Dewirb"2002 #: ' t MY COMMISSION#GO 2750,60
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REVIEWS ZONING SUPERVISOR PLANS uNNNNww ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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