HomeMy WebLinkAboutpermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S oLLLI.cL. ,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential XX
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Electric
PROPOSED IMPROVEMENT LOCATION:
Address: 10851 S. Ocean Dr., 75, Jansen Beach, FL 34957
Property Tax I D #: 451 L-810-0082-000-6 Lot No. 75
Site Plan Name: Windmill Village Block No.
Project Name: James and Lisa Clark
QETAlLED DESCRIPTION OF WORK:
Remove and re laces ower pedestal
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 — Gas Piping _ Shutters _ Windows/Doors Pond
X Electric —Plumbing —Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �jy < <' '� Utilities: Sewer — Septic Building Height:
OWN E RAESSEE: CONTRACTOR:
Name James & Lisa Clank Name; Michael Dale AUlt
Address; 10851 S. Ocean Dr., Lot 75 Company:Ault Bros Inc. Electrical Cout
City: Jensen. Beach, State: FL Address: PO BcK 1528
Zip Code: 34957 Fax: City: Port Salerno State: FL
Phone No. E- Zip Code: 34992 Fax: None
Mail: Phone No 772-283-5520
Fill in fee simple Title Holder on next page (if different E-Mail aultbros@yahoo.com
from the Owner listed above) State or County License ECO001693
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: h/t- A -
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: %
Address:
City:
Zip: Phone:
BONDING COMPANY: ,Not Applicable
Name: *-
Address:
City:
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 conflicts with an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 attorney before commencing work or recording our Notice of Commencement
i
Signature Owner/
of Lessee/Contractor a Agent for Owner
STATE OF FLORIDA
COUNTY OF
s
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this i 2 day of V C-A- J zo2A by
¢� f
FI DCL/ _ -' '- k_ l �
Name of person making statement.
Personally Known OR Prgducecl, Idee tification
Type of Identification Produce a[��
(Signature of Notary Pub ic- S to of Florida)
a
Commission No. ERICA LARSON
(Seal) {�� Notary Public, State of Florida
Commission# HH 167598
My comet. expires Aug. 4, 2022
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