HomeMy WebLinkAboutapp, contract All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater: Permit Number:
�,,, E t� 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 IMPROVEMENTT LOCATION:
Address: ylfv nopis cy _
Property Tax ID#: � =(��` Lot No.
Site Plan Name: Block No.
Project Name: 1Ah i `WY�S
DETAILED DESCRIPTION OF WORK:
i
New Electrical Meter Second Electrical Meter (Affidavit required)
FCONSTRUCTION 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 _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �"l M� Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name t Name:W �
Address: \u • �. ` Company:
City: 1PnS' 0i State: Address: k
Zip Code: �t Fax: City: i State
Phone No. � " � E- Zip Code: Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County icense
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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or ap a;tprneyaWbre commencing work or recording our Notice of Commencement.
Signature of Cont ctor- r-Owner Builder as applicable
STATE OF FLOR
COUNTY OF
Sworn to;or affirmed and,su_bscribed before me of Physical Presence or Online Notarization
th's , ' day of J20y
V�( 'i
Name of person making statement.
Personally Known OR Produced Identification
Tyke of Identification Produced
(Signature of Notary Public-St a of Florid , DANIELLEGONCALVES
'+ °* PAY COMMISSION#GG 232046
Commission No. (Seal)
EXPIRES:June?_7,2022
"PF °� Rondos Thru otanl�uu^"Und..niti_efS-1:
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev
i
*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*
Proposal / Agreement
Roy Williams December 15, 2021
116 Island Dunes Cove
Jensen Beach, Florida 34957
(772) 485-0503
rov748roy(&ao1.com
1) Energized Electric will supply and install 2- 200 amp Service entrance rated
automatic transfer switches outside by meter.
2) Extend generator service from inside ]-box to new transfer switch location.
3) Obtain permits & Drawings.
Discount due to Energized Electric installing wrong -$2,970.00
-,
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
$25.00 or 3%whichever is greater.
Proposal/Contract pricing good for 30 days from Proposal/Contract date
$0 is due @ Completion
We appreciate the opportunity you have extended us to quote on this work and would
like to thank you in advance for your consideratio''
Authorized signature
Mike FI man
Acceptance of Proposal
I, (printed name), authorize Energized Gas to
complete the work in accordance with the above specifications and conditions. I agree to pay as per
terms outlined abov
Date
Signature
$3 c r i J (h a � i d��'�c s n' ;s K �) \, F �{i'U r'n F Est r YN 'lg OrTI u 4-�� �U� O ��ri G uGLiu�lE ��L.;J��3 . �IJJJ G�� �ufrr,�:,4u�� 'u G- u�'JQ t'��tiCyu' C�Suc��ii.� �i�..=r., �Gc,�'ti�G1;% lyr�F3� cc On sty c]Ct
ow dmakes a uv;r)(DSKr for argj r>eve sa. 'Mo b5nI C ',e OuF9eIr' &A, MN Fjf� er PUu° G�c7 'oava' been
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,the
typed or written language shall govern.
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