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HomeMy WebLinkAboutJob 7737609 - Permit Application w Survey (Signed)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 03/11/22 Permit Number: LU cl Building Permit Application Planning and Development Services Building and Code RegulationDA41on Commercial Residential x 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (7721 462-1578 PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION: Address: 533 Ulrich Rd Fort Pit I- FL 3`I 11 Z Property Tax ID11: 3410-603-0093-00-7 Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: - Set stand alone 200 ama meter main combo on unistrut. _ New Electrical Meter X Second Electrical Meter CONSTRUCTION INFORMATION: 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 Total Sq. Ft of Construction: Cost of Construction: $ 1800.01 NIA _ Generator Sq. Ft. of First Floor: Roof Pitch NIA Utilities: _Sewer _ Septic Building height: I OWNER/LESSEE: CONTRACTOR: Name Jose and Leta Guzman Name: Donald Green Address: 1020 His ana Ave Company: Don Green Electric City: Fort Pierce State: FL Address:1305 W 151 5t Zip Code: 34982 Fax: City: Fort Pierce State: FL Phone No. 772-332-9949 Zip Code: 34982 Fax: _ E-Mail: lct;amackessylOgyahoo.corn Phone No (772) 418-5739 FIII In fee simple Title holder on next page (If different E-Mail permits@dongreenaledric.tom from the Owner listed above) State or County License EC13007447 If value of construction is 2500 or more, a RECORDED Notice of Commencement Is required. H value of HAVC is $7,500 or more, a RECORDED Notice of Commencement Is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION - DESIGN ER/ENGIN EER _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 certtfy 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 is In conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consutt with your Home Owners 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 Lude 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. e i Dv.' e w Signature 6f Owner/ Lessee/Contractor as Agent for Owner SignatureL& Contractor/License Holder STATE OF FLORIDA COUNTY OF — Sworn to (or affirmed) and subscribed before me of x Physkal Presence or Online Notarization this _ day of . 2022 by STATE OF FLORIDA COUNTY OF -- Sworn to (or affirmed) and subscribed before me of x Physical Presence or Online Notarization this _ day of . 2022 by Doe Grow Don Gr"n Name of person making statement. Name of person making statement. Personally Known x OR Produced Identification Personally Known x OR Produced Identification Type of Identtflration Type of Identification Produced Produce 7L' Notary Public- Stat No. 2 (Signature of Notary Public- Statef Commission No.I LAURIE weryPublic- r J Commisalon ar` �, My commis 'r,wa`Y tutury PS Flori Bel f fires ""'• LAURIE PHI 3 ' -. 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