HomeMy WebLinkAboutadam markow permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
91�. L urc_,M_'�'J
TIC, OF-
G C" . 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 9400 Briarcliff Trace Port Saint FL. 34986
Property Tax ID #: 3322-801-0031-000-3
Site Plan Name:
Project Name: Adam Markow
DETAILED DESCRIPTION OF WORK:
Add 240 Volt 60amp circuit for Tesla Wall Connector
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
✓ Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 1,600.00
_ Gas Piping
_Sprinklers
Lot No. 26
Block No.
_ Shutters _ Windows/Doors Pond
_ Generator _ Roof
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Adam Markow
Name: Daniel DuBois
Address: 9400 Briarcliff Trace
Company: DuBois Electric M.D. Corp.
City: Port .Saint State: EL_
Address: 4755 SF ElyiP HM RtA #1527
City: Port Salerno State: _J"
Zip Code: 34986 Fax:
Phone No. E-
Zip Code: 34992 Fax:
Mail:
Phone No 772-987-5ti39
Fill in fee simple Title Holder on next page (if different
E-Mail DubQi5electrigmd@9ma2i.com
from the Owner listed above)
State or County License E013007817
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:
DESIGNER/ENGINEER: _ 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 conflicts with any 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 your Notice of Commencement.
Owner
Signature Of GiAtrador- r - Builder as applicable
STATE OF FLORIDA
COUNTY OFF-�1 1l
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this_LQ day of Fe�o_ ,20�ZZbj
Name of person making statement.
Personally Known OR Producd Identification
Type of Identification Produced Y' l 0
(Signature of Notary Public- State of Florida)
Commission No. (Seal) ;=ti��r� DEBORAHVINCESLIO
Notary Public - State of Florida
�';'
. Commission 0 GG 414343
....... My Comm. Expires Sep 18, 7023
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