HomeMy WebLinkAboutScan_0928.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S `n. LLL
.J,lj
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: Electric install for generator
PROPOSED IMPROVEMENT LOCATION:
Address: 112 Island Dunes Cv, Jensen Beach, FL 34997
Property Tax ID 4. 3534-503--0005-000-8
Site Plan Name:
Project Name: Hribar
DETAILED DESCRIPTION OF WORK;
Electrical installation for 20KW Renerator
New Electrical Meter Second Electrical Meter
CONSTRICTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
,Mechanical _ Gas Tank _ Gas Piping _ Shutters
X
(Affidavit required)
X
Lot No. 4
Block No.
Windows/Doors Pond
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 2,495.00 Utilities: _Sewer _Septic
OWNER/LESSEE: CONTRACTOR:
Building Height:
Name Car; & Sh•rry liribar Name: Michael Dale Ault
Address: 411 RAs-rve Trail Company:Ault Bros, Inc Electrical Contractor
City- Chargin Falls State: OH Address. PO Box 1528
Zip Code: 44022 Fax: City: Port Salerno State: FL
Phone No. E- Zip Code: 34992 Fax: None
Mail: Phone No 772-283-5520
Fill in flee simple Title Holder an next page (if different E-Mail aultbros@yahoo . com
from the Owner listed above) State or County License ECO001693
11 vol— VI L.VIIJLI UI LIVI I V c7uV ur rnVre, a MMUKUtU niouce Or 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: _!I/ Not Applicable
Name: _
Address:
City:
Zip:
Name: _
Address:
City:
Zip:
Phone
Phone:
State
Not Applicable
MOIRTGAGE 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 au:horixe 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.
ignature of Contractor - or -Owner Bui der as appl cable
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STATE OF FLORIDA� e
OF
COUNTY � 4/
SworrLto (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of , 20-9by
Name of person making statement.
Personally Known OR Prod uce_cL,Identification
Vo"
Type of Identification Produced rL SIJI�
{Si ature o tary Public- State of Florida}
Commission No. _� � / � 5ealj
_ r Notary ►ublK -
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