HomeMy WebLinkAboutBuilding Permit Application 4812 Myrtle DrAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06/17/2021 Permit Number:
Sn i_.UULGL,
`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: 4812 Myrtle Dr
Property Tax ID #: 3402-608-0151-000-2 Lot No.7
Site Plan Name: Block No. 43
Project Name: Weintraut-Sullivan Residence
[DETAILED DESCRIPTION OF WORK:
Run dedicated circuit to feed new GFI outlet for septic pump and alarm box.
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: $ 748 Utilities: _ Sewer _ Septic Building Height:
OWNERfESSEf ;
Nil WiM,
Name: Kent Blosser
Name Paula K. Weintraut-Sullivan
Address:4812 Myrtle Dr
Company:Blosser Electric
City: Fort Pierce State: _
Zip Code: 34982 Fax:
Address: PO Box 7305
City: Port Saint Lucie State: FL
Phone No.772-353-6884
Zip Code: 34985 Fax:
E-Mail:AIICoastSepticinc@gmail.com
Phone No772-337-0055
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail electricinc.info@gmail.com
State or County License EC1 3001570
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.
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: You i re to Record a Notice of Commencement may result in paying twice for
improvements to pro erty. A Notice of Commencement must FrNoIrtice
orded in the public records of St.
Lucie County an osted n the jobs efore the first inspection. Itend to obtain cing, consult
with lender ocean atto ey befoye c encing work or recoroin� of Comm ment.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR%DA STATE OF FLORIDA
COUNTY OF c�5f-JJ'_I6_t COUNTY OF � LA jClf
;iWdayof
(or affirmed) and subscribed before me of
sical Presence or Online Notarization
lAOc- , 202 by
�
Name of person masking statement.
Personally Known`/ OR Produced Identification
Type of Identification
Produced
Swor to (or affirmed) and subscribed before me of
Physical Pre ence or Online Notarization
this L'7 day of Xlr& 20� by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Publl
Signature of Notary Public- St
a ALISON HANSON
Q
a�?o ., ALISON HANSON
'
ommission No.
OMMISSION # GG
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Commission No.
�: My60M�ISSION#GG970043
a. PIRES: March 16, 2
^:• ; e EXPIRES: March 16, 2024
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