HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
9Vo LL(M1
Q 4_
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) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: 6o_)�
PROPOSED IMPROVEMENT LOCATION::
Address: EL1CC
Property Tax ID #: L' W Lot No.
Site Plan Name: , p Block No,
Project Name: V
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter.
(Affidavit required)
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -- check all that apply:
Mechanical _ Gas Tank Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
eV
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: " Sewer — Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name (�� S
Name:
\CAX
Address: n k
City:~ r7� l Stater
Zip Code: s5 ` t�.4� G Fax:
Phone No. ` E-
Company: t \
Address:
City: �'�
Zip Code: Gi I
Phone No
E-Mail P 1
_State: y�
Fax:
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
l o
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires. I
II If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
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 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 az 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 t jobsite before the first inspection. If you intend to obtain financing, consult
with lender or n attorne fore commencing work or recording our Notice of Commencement.
Signature of Coy,Ur for - - Owner Builder as applicable
STATE OF FLORI�
COUNTY OF
`c Physical Presence Online Notarization
Swoj' to (or affir- ) and s b crib d before me of or
`
this day of 20 ,by
Irww ICaX A io
Name of person making statement.
Personally Known V_ OR Produced Identification
Type of Identification Produced
A ' �� LI
(Signature of Notary Public- State of Florida)
Commission No. (Se s""'" DANIELLE CUPJCHLVES
)
,My COMM14SION It 1i1, 2 S?946
I
/A" 022.
Rrndp Thn Noki'r,PuNIGUndemrlters
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N tl3WiFiiJ�-YDS-RWeteRN..Affiuv Ja 'bYDY4'%°v'Aml¢f6i�`
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 1u/1L/Ll
D
*Treasure Coast 772-466-1095, 4252 Bandy Blvd, Fort Pierce, FL, 34981, Fax 772-318-6672*
*Palm Beach 561-752-0214, 2758 Old Okeechobee Blvd, Suite 9, West Palm Beach, FL, 33409*
*Sebastian 772-778-0131, 725 Commerce Center Drive Suite J, Sebastian, FL 32958*
*Energized Electric Gas Department 772-241-5279, 4258 Bandy Blvd, Fort Pierce, FL, 34981
Proposal / Agreement
Ann Vargas October 12, 2021
127 Queen Isabella Court
Fort Pierce, FL 34949
(772) 466-5862
avargarn65@gmail.com
1) Energized Electric to install underground gas line to generator from existing
propane tank and final connect.
2) Obtain all permits & inspections needed,
for the sumo : $1,39 • o®
TERMS:
Charges & Payments: Charges are due in full at time services are rendered unless otherwise stated below. Contractor may
{ charge and customer agrees to pay a late fee for all past due payments, such fees not to exceed the maximum allowed rate by
applicable law. Customer shall be responsible and agrees to pay for all charges billed, applicable taxes, applicable legal fees and
other charges/fees. Customer shall be responsible for any stop payment, charge backs or returned checks in the amount of
s25.00 or 3% whichever is greater.
Urass will be replaced up to 100 square feet or any lawn damage that may be caused due to excavation. Will repair any minor j
i Sewer or sprinkler line damage due to excavation. f
proposal/Contract pricing good for 30 days from Proposal/Contract date
I $ 495.00 due @ Signing
$ 700.00 due @ Gas Line installation
200.00 due @ Final Inspection
We appreciate the opportunity you have extended us to quote on this work and would
Yke to thank you in advance for your consideration.
Authorized signature:
John Maruri 772-626-4691
Acceptance of Proposal
I! ,--�Y-) \/c&r q i- (printed name), authorize Energized Gas to
complete the work in accord nce with the above specifications and conditions. I agree to pay as per
terms outlined above.
Date
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 agreements: there are no other agreements, representations or warranties not
set forth herein. If any conflicts exist in this agreement between terms which are printed and those which are typed or written, tr*
typed or written language shall goverf3.
Page 2 of 3
CONTRACT TERMS AND CONDITIONS
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 proposail.
$395.00 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
'� n C-) (-� \/(,. rC
PRINTED NAME
/C'
( atA�))
SIGNATURE
DATE
Page 3 of 3