HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0912812021 Permit Number:
,S-1: LI CLL=
` Building Permit Application
Planning and development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: New service; New temporary service
PROPOSED IMPROVEMENT LOCATION:
Address: 11700 West Midway Road, Fort Pierce, FL 34945
Property Tax ID R: 3304-603-0004-000-1 Lot No. 3
Site Plan Name: WESTMIDWAY (PEI 45-1) Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Build one (1) new 200 amp service and one (1) new 200 amp temporary service.
New Electrical Meter X Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors _____ Pond
_ Electric —Plumbing Sprinklers
Total Sq. Ft of Construction: N/A
Cost of Construction: $ 2287 56
"Generator _Roof Pitch
Sq. Ft. of First Floor: N/A
Utilities: _ Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Bryan Wester and Tara D'agostno-Westor
Name: Donald Green
Company: Don Green Electric
Address- 5299 NW Torino Lake Cir
City: PortstL-ode State:_
Zip Code: 34986 Fax:
Phone No. 772-985-609B
Address: 1305 W 1st St
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No (772) 418-5739
E-Mail permits® dongreenelectric.com
E-Mail: tara349520 aol com
FIII in fee simple Title holder on next page ( if different
from the Owner listed above)
State or County License EC13007447
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:
DESIGNERJENGINEER: _ 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 the jobsite before the first inspection. If you intend to obtain financing, consult
withJlnder or an Rttornev before commencine work or recordirAvour Notice bf Commencement.
Sign u of Owner/ Lessee/Contractor as Agent for Owner
Signature ontractor/License Holder
STATE OF FLORID,4
STATE OF FLORICIA
COUNTY OF 1.1111 4 ui pf tI
COUNTY OF IS f
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
✓ Physical Presence or Online Notarization
✓ Physical Presence or Online Notarization
This JA ( day of St 0 �iX , , 2020 by
this ZL day of t 2020 by
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Name of person making statement
Name of person making statement.
Personally Known J�_ OR Produced Identification
Personally Known 'Ile OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- S
ure of Notary Public- Stat
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