HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
D 4 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:
661,11
PROPOSED IMPROVEMENT LOCATION:
Address: ,'140�) ') 1� boGk� c eoEk ?1euea. fi— T-IGY S
Property Tax ID #: Lot No.
Site Plan Name: ((}} Block No,
Project Name:
J'
DETAILED DESCRIPTION OF WORK:
M)�� -( 1 0� (AC i>' \iIx_0
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
Electric _ Plumbing `Sprinklers
Total Sq. Ft of Construction:
uu
Cost of Construction: $ � 3 9
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OW N E RAESSEE:
CONTRACTOR:
Name �1IS—JE-19Name:
Address: �(� t,t_�_���
City: Ic rcit Stater_
Zip Coder Fax:
Phone No. �'_.C(' ��
E-Mail:
i (
Company 1
Address:
City: � State:.
Zip Code: Fax:
Phone No�,[
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License)�
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
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 card a Notice of Commencement may result in paying twice for
improvements to your proper,- . A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on-' e jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an at orn efore commencing work or recording our Notice of Commencement.
Signature of O ner'/ LessContractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SkAi
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this jJ� day of 2031E by
la
Name of person making statement.
Personally Known -`'t- OR Produced Identification
e of Identification Produced
(Signature of Notary Public- State of Florid
;RV via •. DANIELLE, GONCALVES
Commission No. MY COMMISSION# GG 232946
4' EXPIRES: 3une 27, 2022
7pC
•;Eo,'s��� Bonded ThtuNQ4.NPublic Underwnler5
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
*'tteasuro Coast 772-466-1095, 4252 Bartdy l3lvd, Fork fierce, F" , 34981, .Fax 772-318.6672*
4`Palm Beach 561752.02t4, 2758 Old Okeechobee Blvd, Smite 9, West Palm Beach, F^Lo 33409*
*Sebastiap 772,778-0131, 725 Connnerce Center Drive Suite J, Sebastian, FL 32958*
*Energized Electric Cass Department 772-241.5279, 4258 Bandy Dlyd, Dort Pierce, FL, 34991*
Proposal ;/ Agreement
Christine Breene
2405 Trowbridge Road
rort pierce, FL 34945
514-599-�393
breene2S7@msn,com
July 15, 2021
1) Energized Electric to install undergrotind gas line to generator from existing
propane tank and final connecc
Obtain all permits & inspections needed,
i�'O.r the suett 41.
TE
Charges a Payments: Charges are due in full at time serve
charge and customer agrees to pay a late fee for all past due
applicable law. Customer shall be responsible and agrees to p
other charges/fees. Customer shall be respor slble,for'any s
$25.06 or 3% v
iarass will be replaced up to.100 square feet or any lawn don
sewer or sOrInkler line
'$ 49$R00 due
$ 700.00 due @ Gas
endered unless otherwise stated bolom Contractor may
rs, such fees not to exceed the maximum allowed rate by I
charges billed, applicable toxes,'epplicable legal fees and
cent, charge backs or returned clecksin the amount of
Is greater,
mbe caused due to excavation. Will repair any minor
due to excavation.
s from Proposal/Contract date
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
IJ '(Print@d Reirige)f,arythorize,Energized Gas to
complete the work in accordance with the above specifications;and cOpgitions, 1;apree to pay as per
terms outlined above.
Date 91 to (202'I
'Signature
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 fro otheregreements,'representatiens or warranties not
set forth herein. "if any conflicts exist'irl this i#groement,between terms which ere;printed and' those,which,are typed.orwritten, 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, industryode.
This =tract.price does NOT Include bonding gas lines, converting outlets, converting appliances or
carbon monoxide detectors
Additional charges may apply If rack 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
toobtain final approval.
If home is located in flood zone, the additional Cost will be the responsibility of the homeowner If a tank tie
down, orbuoyancy 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.
sago 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
'age 3 of