HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^^ I
Date: Permit Number:
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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
RECEIVED
DEC"on .7018
Permitting Department
St. Lucie County
Commercial Residential ✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line II
PROPOSED IMPROVEMENT LOCATION:
Address: 8550 Belfry Place
Legal Description:
Port St. Lucie, FL 34986
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PropertyTax ID k: 33Z1- 1m— c)(34p-000-1 Lot No.E7
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Site Plan Name: Block No.
Project Name:
'Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
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Tes lo. Pow eX w of s
('CONSTRUCTION INFORMATION: III
_ HVAC _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ at 1' Z?J
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof = Roof pitch
Utilities: —Sewer _Septic Building Height:
I OWNER/LESSEE:
CONTRACTOR:
Namer Jackie Gallardo
Name: lCh61CLS -PcV n5 FIr0 nCA
Address:8550 Belfry Place
Company: Tesla Energy Operations, Inc.
City: Port St. Lucie State: FL
Zip Code: 34986 Fax:
Phone No.2392232724
Address: 8500 Parkline Blvd. Ste 100
City: Orlando State: FL
Zip Code: 32809 Fax:
Phone No. (813)431-0923
E-Mail; jackiegallardol@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: emccurdy@tesla.com
State or County License: EC13006226
IT vaiue or construction is yZ5110 or more, a RECORDED Notice of Commencement is required.
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'LEMENTAL CONSTRb&ION4LIEN LAW=INFORMATION. _ `J 11010
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:T-1-
_
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in convict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult 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. 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 vour Notice of Commencement.
Signature ofContractor/License Hol e
Signa� ooOwner/ Lessee/Contractor as Agent for Owner
STATE OF FLO IDA
STATE OF FLORIDA
COUNTY OF C
COUNTY OF Orc"r)q P✓
The forgoing instru ent wa acknowledged before me
this I
The forgoing instrument was acknowledged -before me
( dayof )A[0_M� 20� by
this�dayoft`()\i 20j2'by
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'Name of person making statement
Name of person making statement
Personally Known OR Produced Identification r
Personally Known OR Produced Identification
Type of Identification
Produced J71 F� V�4_n ao1i_ec)
Type of Identification
Produced
(Sign Notary 'public- State I IUO
t3ignature fN to lic 4 lorida A E L R
rr� C I¢�� ;.,HOLLYS A.
No. FI"6 1 6ov°Notary Public -
F LOMENA r State of Florida -Notary PuCommission
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Expire
S a(�ghHpQQrb No. Cqq�¢n�m''ysionflGG1493ZCommission
a FF 986660 �• mission
October08.2021
'•%�E,,,�o?•° My Comm. Expire
Apr 27, 2020
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DATE
COMPLETED
nev. is/2/1i