HomeMy WebLinkAboutHumphreys Building Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number
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>3 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: 10725 S Ocean Drive, 4145, Jensen Beach, FL 34957 -Holiday Out at St, Lucie BLK 1 Lot 5 and equal pro-rata interest in common elements (OR1259-2170)
Property Tax ID #: 4511-501-0268-000-5 Lot No.5
Site Plan Name: Humphreys Block No. 1
Project Name: Humphreys
[DETA1LE:DDESCRIPTION OF WORK:
Changed Jaws per FP&L request (Emergency)
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: $ 500 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Robert Humphreys Name:James D Brown
Address:18356 Hall Road Company:Jim Brown Electric, LLC
City: Casnovia, MI State: _ Address:3352 NE Skyline Drive
Zip Code: 49318 Fax:n/a City: Jensen Beach State: FL
Phone No.616-893-4251 Zip Code: 34957 Fax: Ofc#: 772-209-0280
E-Mail: Phone No Cell #: 860-803-5333
Fill in fee simple Title Holder on next page ( if different E-Mailidb5333@gmail.com
from the Owner listed above) State or County License30871 I
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
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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; vour Notice of Commencement.
re of Ownerl Less elContractor as A� t for Owner
STATE OF FLORIDA
COUNTY OF t\,\ :. t-4-,
Sworn to (or affirmed) and subscribed before me of
t�i�iyslcal Presence or Online Notarization
this 'L`l cTay of f t.2020 by
ense Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
L_ Physical Presence or Online Notarization
this D--) "day of o� , 2020 by
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Name of person making statement. Name of person making statement.
Personally Known , — OR Produced Identification
Type of Identification
Produced'T-Ic.r. cAc.
c,,oLLe,.(�
(Signature of Notary Public- State of Florida )
Commission NoC- - C Isi Lu
REVIEWS
DATE
RECEIVED
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Personally Known Lr OR Produced Identification
Type of Identification
Produced F"Wr U alc—
I � C_OC,A_P�-
(Signature of Notary Public- State of Florida )
mission No.(,L 1 S/ I °d I (Seal)
VEGETATI
REVIEW