HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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)462-1575
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: S r (� (
Property Tax ID#: `)�' �V l �L] ` Lot No. V
Site Plan Name: Block No.
Project Name:
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 T Gas Piping _Shutters _Windows/Doors _Pond
—Electric J Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name } Name: 'I k( -ij j yA Yz)
Address: Company:
City: EhslStately. Address: V
Zip Code; Fax: City:
�, e(�p State:
>g Phone No. Zip Code:� cig Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail `t
from the Owner listed above) 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.
SUPPLEMENgLCONSTRUCTION LIEN LAW INFQRMATION
4
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 Count yY 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 propert . A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on t jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an atto;ney ore commencing work or recording our Notice of Commencement.
.,.11
Signature of Owner/ e ee/C ntractor as Agent for Owner
STATE OF FLORIQ
COUNTY OF G A ' C s,
Sw n to or affir d)and subscribed before me of 'Physical Presence or_Online Notarization
thi n ay of X_\ — 20�11 by
YI C'AJry1Ctr)
Name of person making statement.
Personally Known \'_OR Produced Identification
Type of Identification Produced
(Signature of-Notary Public-St-ale of Florida) �o��Hij�-.,, DANIELLE GONCALVES��
MY COMMISSION#GG 232946
Commission No. (Seal) EXPIRES:June 27,2022
Hondud ihm Notary Publio Undomritors
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
*Tteasurc Coast 772466-1095,4252,Bandy Blvd, Fort Fierce, FL,34981, Fax 772 118-6672`
*Paalna Beach 561-752-0214,2758 Old Okeechobee Blvd, Suite 9, West Palm Beach, FL,33409*
*Sebastian 772-778-0131, 725 C oinmeroe Center Drive cite ad;Sebast`sm,[y'L 32958*
1 Ti4 c ued l lectr c G Ls 13e arunent 772-241-5279,4258 Bandy Blvd, Fort Pierce, FL;:34981
Proposal / Agreement
Bonne Ring July 21, 2021
8298 Spicebush "terrace
Port St. Lucie, Florida 34952
(772) 879-3123
steye@n El -en, rprises co4'3'a
1) Energized Electric to supply& install underground gas line from Natural Gas
Deter to generator and final connect.
2) Obtain all permits & inspections needed.
for the sum raf: a,.x „tea
♦ TCR.MSx
Charges&Payrments.Charges are due In full at time services are rendered unless otherwise skated below. Contractor may,
charge and customer agrees to pay a late fee for all post due payments,such fees not to exceed the maximum allowed rate by
applicable law, "Customershali be responsible and agrees to pay for all charges billed,applicable taxes,applicable legal fees'
and other cha rges/fees
Proposal/ConCraotprioing goad for 30,:days from:Proposai/Coeptract dote
.
49 .00 due @ Signing
500.00 due 0 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 stgnature',
John Marun 775-626.4691
A e�itance or Proposal
I, Y { rl�ruli if� _ _ (printed name), authorize Energized Gas to
complete the wprlr in aC ordarice with the above specif ations and conditions, I agree to pay as per
terms o dined above;
` - _ Date9191P-01.4
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 agreementc: therm are no other agreements,representations or warranties not
set Forth homin, 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
r
CONTRACT TERMS AND CONDITIONS
Y
Installation will comply with all local and state;regulations and be,consistent with standard Industry code.
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;
$39 .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;
PRIN ED NAME
,/2ZU-L ,
SIG TURF DATE
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