HomeMy WebLinkAboutgen app, contractAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
CBDG Funding
Residential,/
PROPOSED IMPROVEMENT LOCATION:
Address: i �.1441�- t J
Property Tax ID #: 1� "l Lot No. ll44
Site Plan Name: Block No.
Project Name: �� AfT)
DETAILED DESCRIPTION OF WORK:
l
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
hu
_ Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor.
Cost of Construction: $ } 9C '8 Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name fb H
Name:
Addres . pi;_ li00
City: State: _J2J
Zip Code: Fax:
Phone No._[�i; • ���� E-
Company:
Address:
t v
City: '4Q
Zip Code 1
Phone No
E-Mail 2L Lo nZ
State-�._
Fax:
0 Gr
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above]
State or County License
y 1 _J
1 Lam/
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
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
State
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable I BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made toobtain a permit to do the work and installation as indicated.
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 pro erty. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted n the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or av attorgyrey before commencing work or recording your Notice of Commencement.
Signature of Can ractor - r - Owner Builder as applicable
STATE OF FLORI
COUNTY OF
Sworn to (or affirmed) and subscribed b ore me of Physical Presence or Online Notarization
_sj
this � day of �' _, 20 by
Name of person making statement.
Personally Known >< OR Produced Identification
T�A�of Identification Produced
(Signature of Notary Public State of Florida)
l
D NIELLE(�)r ALWS
Commission No. (seal) i =.
.
r d^, i . T L' N ata; P[ iic Up., d' . 'Crs
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
YAMM
t=_ _
4252 Bandy Blvd. Foil_ pl(''It ,,1 ,!
125 Commerce C h. Di. St.e. 1 r•i,,r I1,111 I I
'71,,3 Old QI<(ior'Iuohoc Itl rcl- `ae eI VY, .III Il I .. ,. I;, 1 1 ,4IJ'. i ,1:,
PROPOSAL / CLIENT AGREEMENT
Customer(s) Name.• _ -M Cu1eY.t ; 5,01 1 k. W"
II p 1 � r — ---
Address: l D f '
City: _—. P..S . L-- ST T _.�— 21p
�I �/krrro rw.��v0-7 - !(04
Home: Cefi:,
!!Q vcm hAc
Email:
Additional Info:
Generator / Electric Proposal: Kohler kw / model #
Generac # 12kw 18kw 22kw 24kw # of L/S:-!---
# Transfer Switch(s): # of Main(s) I Main Breaker Size
i
Warrantee Term: f O yrs. Electric Dist. Total oma- Extended 3
Cx•T [ si�a f� I •�
Including: Delivery, Set up, Preformed Concr to Pad, Win Monitoring Device,
Labor, Battery (1 yr, warr.), Materials & All Permits Required by Town or County
���m 14Ic2 IUlc}1il S�W1.4
Propane or Gas Quote
_I New Propane Tank (size): 250gai, 500gal. 10009al. Other:
Existing Natural Gas / Propane Connection Required: Yes
Fuel Line Distance: Total _ i Gi ft. Extended Service _ €t,
AG: UG: ✓ Strapped Stub Out: Yes __ ___ No
Additional Info:
Additional Products and Services:
Whole House Surge Protector_ Sub Panel Range Ext. _ 4G LTE _
Other:
Payment Terms:
Total Deposit Due on Signing Agreement
$f(
Total Due Upon Released of Permits
$
Total Due Upon Electric & Gas Installed
$
Total Due Upon Generator Delivered
$
Total Due After Final Inspection & Start Up
$
Joe -
Day I oat, / r1mn
r, / F,�6 OLL—�3 U
HDA:
Yrn rlfi
Hatura"&sLExlstin4 PPrD9ane:
Yes , rin
el'a of I M
S.f. [?t'-c total
Generator Quote:
Gen. + Install. $ } €
Discount / Coupon: $ "?
Quote Amount: $1
Propane / Gas Quote
Gas / Propane Install
& Connections:
Discount / Coupon: $
Quote Amount: $ TZ--G
Total Quote: Gas & Electric
This price is valid for 30 days
Deposit Amount per Service:
Generator: $
Gas/Propane: $
Follow Up Oates:
ACCEPTANCE OF PROPOSAL
1, Empowered SOILIIIGIIS (printed name), authorize Energized Electric to complete the
work in accordance with the above specifications and conditions. I agree to pay as per terms outlined above and to
addi7,94 termsback.
//��////�,////�y// 311 12022
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