HomeMy WebLinkAboutBUILDING PERMIT APPLAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date Permit Number:
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P s rj -- Building Permit Application
Plorning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phcne: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 13827 S Indian River Drive, Jensen Beach, FL 34957 - Lake Manor Park Cooperative Site 21 (OR3280-1821)
Property Tax ID #: 4509-805-0021-000-8 Lot No.
Site Plan Name: Lake Manor Lot 21 Block No.
Proje--t Name: Lake Manor Lot 21
DETAILED DESCRIPTION OF WORK:
Install new meter can, new 100 Amp Disconnect, new mast, new weatherhead, and new wires & post.. Meter # ACD7285
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: $ 2,000.00 Utilities: _ Sewer _ Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
NameJeffrey & Maryann Peterson Name: James Brown
Add -ess:117 W Muntz Avenue Company: Jim Brown Electric, LLC
City: Buttler, PA State: Address.3352 NE Skyline Drive
Zip Code; 16001 Fax: City: Jensen Beach State: FL
Phone No. Zip Code: 34957 Fax: Ofc# 772-209-0280
E-M3il:_ Phone No Cell# 860-803-5333
Fill 111 fee simple Title Holder on next page ( if different E-Mailidb5333@gmail.com
from the Owner listed above) State or County License30871
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:
Ut51GNER/ENGINEER: _ Not Applicable
Name: —
Ad c ress:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:_
Adcress:
City:
Zip:
Phone:
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv;
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 your Notice of Commencement.
re of Owner/ Lessee/contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of �_—ghysical Presence or _._ . Online Notarization
thisS jt day of_ - �A , 20 )-1 by
Name of person making statement.
Personally Known --i .�R Produced Identification
Type of Identification Produced 'f L" d.r- -0r , C l4 .
(Signature of Notary Public- State of Florida) KAREN CODERRE
�r MY COMMISSION # GG 981001 Commission No-- (Seal) _■:
`•} 4' EXPIRES: Apri123,2024
Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW I REVIEW
DATE
RECEIVED