HomeMy WebLinkAboutBuilding Permit Application 10987 S US Hwy 1 (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
LU
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° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: 10987 S US HIGHWAY 1
Property Tax ID #: 3414-501-6210-400-9 Lot No.
Site Plan Name: Block No.
Project Name: Lightbox Peace Ave
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
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: 24 Sclu'
Cost of Construction: $ $2350.00
Sq. Ft. of First Floor:
Utilities: Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Gambina 7320 LLC
Name: Adam Chapman
Address: 703 SW Goldshine CT
Company: Adam Chapman - Adam Chapman Electrical Services LLC
City: Palm City State: FL
Zip Code: 34990 Fax:
Phone No. E-
Address: 1034 NW PINE LAKE DR
City: Stuart State: FL
Zip Code: 34994 Fax:
Phone No 772-285-1380
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail adamchapmanll@aol.com
State or County License EC13006096
IIIf value of construction Is 2500 or more, a RECORDED Notice at Commencemenr is reguirea. II If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is riereoy mane to ootam a Pei mn tV UV .11_ .... o • •••-.-••-••-•• --
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes
Yno representation that is granting a permit will authorize the permit holder to build the subject structure
structure. Please consult with your Homeowners Association anld review your deed for any restrictions whilch may apply. such
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,
accessary 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 Coynty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
.. 1_1___ _—_�,.....:..... -A, nr rnrnrriina vnnr Nntirp of Commencement.
with le er or n atturne uelute uununON.ui -- -- -- - -
Sig a of Owne essee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirm d) and subscribed before me of
Physical Presence or _ Online Notarization
this L day of ��__a p_Ur mh3Q_ 20_ by
Name of person making statement.
Personally Knt� Produced Identification
Type of Iden ficatio rodu
(Signature of Notary Public- State f Florida)
Commission No. (Seal) Notary Pubhe State of FIWda
490"ft
Robin
Jacobs
My Commission GG 249966
ww Expires 06n9/2022
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEAT.IRTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/ZUIZ1