HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED yy��Q
Date: 10/06/2015 Permit Number: IS!®- ()(00(f-2
IAN ..ISO
Building Permit Application � � D
Planning and Development Services
Building and Code Regulation Divisionlr
2300 Virginia Avenue,Fort Pierce FL 34982 ®C
Phone: (772)462-1553 Fax: (772)462-1578 Commercial x Residential
PERMIT APPLICATION FOR: p
To Select from dro box, click arrow at the end of line.
PROPOSED IMPROVEMENT LOCATION:
Address: 4200 Johnston Road
Legal Description: 22 34 39 NE 1/4 OF NW 1/4-LESS E200.96 FT OF S 242.92 FT AND LESS N 95 FT AND
LESS S 25 FT FOR RD RNV(36.07 AC) (OR 1233-1620: 1249-2261: 2422-1707)
Property Tax ID#: 1322-211-0001-000-7 Lot No.
Site Plan Name: Block No.
Project Name: Endless Summer Winery
Setbacks_ Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install a new 200 amp over head service on the west side of the property
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC 11 Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 2,029.00 Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Gary Roberts Name: Robert DiPietro
Address:437 Rouse Road Company: Bip DiPietro Electrtic, Inc
City: Fort Pierce State:FL Address: PO Box 1822
Zip Code: 34946 Fax: City: Vero Beach State:FL
Phone No. Zip Code: 32961 Fax: 772-365-0202
E-Mail:Gary Roberts(,rnl@gate,net) Phone No. 772-569-7704
Fill in fee simple Title Holder on next page(if different E-Mail: bip@bipelectric.com
from the Owner listed above) State or County License: EC0002782
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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 thepermit 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 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 our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Si nature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA 1
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing Inst ent was acknowledged before me
this day of (�(' 20 I by this day of 2013 by
'� ' r' Robert DiPietro
(N eoT person acknowledging) (Name of person acknowledging)
ignal ure of Notary Pu-5lic-qate of Florida) \ gnature of Notary Public-Aate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification -
Tae Qt Identification Produced
Type of Identification Produced
Commission No. n No. ��� (Seal ^a M
4, Notary +dAFfJl�td p�polAda 'z° ,
"iP LASHAHNA INGRkMri a
w%
0'. . 9taFyPubIi,;-3j1!eO1 WA
20 ,:
I ftcomm,'Expues Declt a My Comm.Expires Dec 20;201
Revised 07/15/2014 +� ,,, Commission#fiF;17r7249.:; . ,` ocBonaCommission 4E FF 177249
rr. o , ational No
Assn.. ���'� q ;;°p
Nelefy Ass'..
REVIEWS FRONT Z N SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
[INITIALS