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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Permit Number:
9((�� i� �' 1� RECEIVED
1T. L�i�lJl
MAR 2 8 2022
Building Permit Application st. Lude county
Permitting
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300.Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:150amp stand for contruction trailer. V1
PROPOSED IIVIPRQVEIVIE+NT LOCATION
Address: 5 (
Property Tax ID #: - �!�:1 0 :3 Q ,cnn COO Lot No.
Site Plan Name: Block No.
Project Name: Ravinia Port St Lucie
DETAILED DESCRIPTION OF WORK 1_50amp stand for,contrgctlon trader
Install 150amp stand for contruction trailer.
New Electrical Meter Second Electrical Meter (Affidavit required)
CNSTRUCTIONINFORMATION -w
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
X Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 200.00
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _Sewer _Septic Building Height:
011UNER/:LESSE°E s; =
. ,_
CONTRACTOR
Name Tom Pagnotta
Name: John Cavnar
Address: 15481 SW 12th ST Ste 309
Company: Goldstar Electric Inc
Address: 213 NE Sagamore Terr
city: Sunrise State: FL
Zip Code: 33326 Fax:
city: Port Saint Lucie State:FL
Phone No. 5617234050 E-
Zip Code:34983 Fax:
Phone No 7723805913
Mail: tpagnotta@centerlineca.com
Fill in fee simple Title Holder on next page (if different
E-Mail johnc@goldstar-electric.com
from the Owner listed above)
State or County License 23575
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 LAIN INFORMATION 4
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 attornev before commencing work or recording vour Notice of Commencement.
gnature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF 'St. L-UC.t2
Sworn to (or affirme ) and subscribed before me of V Physical Presence or Online Notarization
this25 day of MQrC.,tn 207-7—by
fah n Cav Inat
Name of person making statement.
Personally Known, OR Produced Identification
Type of Identification oduced
(Signature o otary Public- State o orida)
Commission No.49 063bciK3 (Seal
OV Notary Public State of Florida
Paola. Bautista Garcia
gc My Commission HH 063683
'?pRpo'f Expires 11/1512024
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Rev 10/12/21