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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 27 fl L= 18 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- ('o PROPOSED IMPROVEMENT LOCATION: i qr1 Address: ti � 0 f� Property Tax ID#: ���1' �1"1 " l "1' � Lot No. Site Plan Name: Block No. Project Name: LLfLYIn [DETAILED DESCRIPTION OF WORK: New Electrical Meter Second Electrical Meter (Affidavit required) [CONSTRUCTION INFORMATION: Additional work to be performed under this permit—check all that apply: _Mechanical _Gas Tank -:1rGas Piping —Shutters —Windows/Doors —Pond Electric —Plumbing _Sprinklers _Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: uo Cost of Construction: $ Utilities: —Sewer _Septic Building Height: OWNERAESSEE: CONTRACTOR: Name q Name: IC4i)Y LLB Address: �—)(A C-bR-)V-YJCAO Company: t l City: 1 State Address: S`� l v Zip Code: Qk_ © Fax: City: ��11 p Y c( Q Stater Phone No. J p 9-) Zip Code: `D GI� ) _ Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page ( if different E-Mail from the Owner listed above) State or County License_L V-)Sle 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 coniiict 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, Ajotice of Commencement must be recorded in the public records of St. Lucie County and posted on the ' ite before the first inspection. If you intend to obtain financing, consult with lender or an a for commencin work or recording our Notice of Commencement. Signature of Owney Lei ee/Contfactor as Agent for Owner STATE OF FLORIDA COUNTY OF , A ')( Aid Sworn to(or affirmed)and subscribed be ore me of ''Physical Presence or Online Notarization thly,5 � dayof S 20�d\ by 11�1 (��1(Q pQ ��<�1QiV1C�v� Name of person making statement. o' Personally Known OR Produced Identification e of Identification Produced (Signature of Notary Public-State of ,, --' ._,"�nr;+„& DANIELLE QONCALVES Commission No. 5 .+ MYCOMM13SION#GG232946 ., .a. EXPIRES:June 27,2022 Bonded Thru No(ry Public Jndemdtors REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW F r M LU-7-T} � r' R � 5 *Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672* *Palm Beach 561-752-0214, 2758 Old Okeechobee Blvd, Suite 9, West Palm Beach, FL, 33409* Proposal / Agreement James Kiernan 1708 Coronado Avenue Fort Pierce FL, 34982 (772) 538-2778 1708jkk@bellsouth.net 1) Energized Electric to supply & install gas line 40' from Natural Gas Meter to generator and final connect. 2) Obtain all permits & inspections needed. or the sum of., $1 495•00 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 the maximum 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 due @ Signing $ 800.00 due @ 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: Corey Place Acceptance of Proposal I, -jla /K 4— 41 A/1 Jr 41J A (printed name), authorize Energized Gas to complete the work in accordance with the above specifications and conditions. I agree to pay as per terms outlined above. 1' Date `mil Si nature 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. $395.00 of the initial deposit is NON REFUNDABLE if customer cancels after signing this contract or makes a deposit for any reason. No refunds will be given at all after permits have been applied for or installation begins *To include sod replacement a charge of $395 applies. CUSTOMER SIGNATURE FOR ACKNOWLEDGMENT OF ABOVE TERMS 16 PRINTED NAME ($IGNATURE DATE Page 3 of 3