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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
IMT
O �\
` "D Building Permit Application
Planning and Development Services 9 V
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982 pecm�ttLuc;e CaUntY
Phone: (772) 462-1553 Fax: (772) 462-1578 Sr'
PERMIT APPLICATION FOR:
at 7
PROP:QSED IMPRQVEM;ENT LQCgTION .
Address: 8801 One Putt PL., Saint Lucie West, FL 34986
Property Tax ID #: 3334-500-0093-000-8
Site Plan Name:
Project Name: Installation of Generator with install of 500 gal tank
DETAILED DESCRIPTION"OF WORK
Installation of Generator with install of 500 qal tank
RECEIvS10
Lot No.
Block No.
`1- NAU-1
New Electrical Meter Second Electrical Meter
CONSTRUCTION )INFOR`MAT.ION,: =
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers 4c6enerator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ l)-,'44YO Utilities: —Sewer _Septic Building Height:
'OWNER/LESSEE:.' ..
;CONTRACTOR
Name Keith W Hansen
Name: John J Rack
Address: 8801 One Putt PL
Company: Rack Electric
City. Saint Lucie Wes State: FL
Zip Code: 34986 Fax:
Phone No.
Address:153 NW 16th Street
City: Boca Raton State: FL
Zip Code: -33432 Fax:
Phone No 561-391-3550
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail INFO@RACKELECTRIC.COM
State or County License EC13002600
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 i[ AW MATI INFOROfN
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
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 the jobsite before the first inspection. If you intend to obtain financing, consult
with Lender or an attornev before commencing work or recording vour Notice of Commencement.
Signature of @ ner/r essee/Contractor as Agent for Owner
Signat of tract I se Holder
STATE OF FLORIDA
ST TE F FLO D
COUNTY OF o��nn ('fie
e�_
CO C�iL -
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or
Online Notarization
_X—' Physical Presence or Online Notarization
this "22 day of
202Q by
this 7-2— day of Q� _ 202t by
Ic
Name of person making statement.
Name of person making statement.
Personally Known OR Produced
Identification \
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced �qa r .l i t%" .,-
e _
(Signs e f Notary Pub Ic-
t1, a MARIBELLRODRIGU
J"ated
re of Notary Publi , ,a o ,1 IMMISSION#Gf3177988
Commission No.
MY COMMISSION # GG 1
•�.•��5eal)EXPIRES:March4,20ssion
."; +P ;; EXPIRES: March 4,2022
No.Bond �S taryPubl�UndenxrherePBonded
Thru Notary Public Und
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20