HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
U llo LlJ1,JM "I
° . ' ° """ Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: G
PRpPQSE®hl`MPROUr ENT LO`CgTION,; f,,., PA
Address:'A'- i s S �Y1mun )Zitf N Peou, li- 3L-'A2a R
Property Tax ID #: e)Q jo " r%�� ��) \o - ( Lot No.
Site Plan Name:C Block No.
Project Name: )1(Y1(Z$ Ql�t%
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank Gas Piping _ Shutters
(Affidavit required)
Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �1S Utilities: -Sewer _Septic
Building Height:
S5,
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Name Afbd1A S\YYlp5W
Name: WCJ�C.1'A
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Address: gym S\ 6(w' `a`1
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Company: IEWC1,1
City: 12 MJCY( D
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Zip Code: cDV\\
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Stated
Address: LSD-
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City:
Zip Code:
Phone No 11� (
State:
Fax:
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
ILL. 3��Sc�
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.
'
SURRLEIVIENTALCOsNSIRl1CTIOIV
LIEN LAW INFOt_MATIOI
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
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on theyy'absite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev bcommencinR work or recording vour Notice of Commencement.
Signature
as Agent for Owner
STATE OF FLORA(
COUNTY OF
Sworn to (or affirmed) and subscribed be re me of Physical Presence or Online Notarization
this � day of —)LA,LA 209 by
Name of person makin tatement. E_��
Personally Known OR Produced IdentificationT e of Identification Produced ' Bonded Thru N_nWy Public UnderxtHers
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS
RECEIVED
CdiPl7111:1i4d
COUO TER I ROEVI W S REVIEWUPERVISOR I REVIEW PLANS �VREVI WON S EVIEWLE M REVIEGETATIEATURTANGEW
a yly �3°
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 1700 Latham Rd, Suite 2, West Palm Beach, FL, 33409"'
Angela Simpson
4405 S Indian River Dr
Fort Pierce, Florida 34982
717-514-0110
apsimpsonl8@gmail.com
March 11, 2021
1) Energized Electric to disconnect existing generator and reconnect new
generator to gas line and final connect
2) Obtain all permits & inspections needed
TERMS -
Charges & Payments: Charges are due in full at time services are rendered unless otherwise stated below. Contractor may
charge and customer agrees to pay a late fee for all past due payments, such fees not to exceed themaximum allowed rate by
applicable law. Customer shall be responsible and agrees to pay for all charges billed, applicable taxes, applicable legal fees
and other charges/fees
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$495.00 dace @ Signing
100.00 due CO Gas Line Installation
200,00 due @ Final Inspection
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideration.
Authorized signature:
John Maruri 772-626-4691
Acceptance of Proposal
I, f( �(printed name), authorize Energized Gas to
complete the ork in accordahcce wi the above specifications and conditions. I agree to pay as per
terms outlined above.
Date >)i
JIyIIGIIU I
This agreement shall be construed under the laws of the State of Florida. This agreement contains the entire understanding of the
parties and supersedes all previous verbal or written agreements: there are no other agreements, representations or warranties not
set forth herein. If any conflicts exist in this agreement between terms which are printed and those which are typed or written, the
typed or written language shall govern.
Page 2 of 3
CONTRACT TERMS AND CONDITIONS
Installation will comply with all local and state regulations and be consistent with standard industry code.
Installers are not responsible for landscaping repairs as a result of installation*. This Includes but is not
limited to; damaged/broken sprinkler lines and/or damaged/broken water or sewer lines.
This contract price does NOT include bonding gas lines, converting outlets, converting appliances or
carbon monoxide detectors
Additional charges may apply if rock and/or roots are encountered during the excavation process,
Deposit will be forfeited if customer cancels after the permit process is initiated.
Customer is responsible for obtaining HOA/POA approval. Installer is not responsible for customers failing
to obtain final approval.
If home is located in flood zone, the additional cost will be the responsibility of the homeowner if a tank tie
down, or buoyancy pad is required per the building department
A site survey of your property showing all property lines is required to pull a permit and can be submitted
along with this signed proposal.
*To include sod replacement a charge of $395 applies.
CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE TERMS
I r 1M IWAITA
PRINTE6 NAME
DATE
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