HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/09/2017 Permit Number: SLC -1608-0211
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 Commercial x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 14191 Rangeline Road
Legal Description:
Property Tax ID #: 4233-111-0001-000/6 Lot No.
Site Plan Name: Block No.
Project Name: city west
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
electric service connection / Fpl hookup
Additional worK to pe oertormeo under this permit — cneCK allapply:
1_1M
HVAC L_J Gas Tank QGas Piping _ Shutters Windows/Doors
P] Electric ❑ Plumbing 11 Sprinklers a Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.
of First Floor:
Cost of Construction: $ na Utilities: [] Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameST. LUCIE COUNTY
Name: THOMAS P. JEFFERS
Address: 2519 STATE ROAD 16
Company: WEEZER ELECTRIC, INC.
City: FT. PIERCE State:FL
Zip Code: Fax:
Phone No. 772-462-8213
E -Mail: montgomeryc@stlucieco.org
Address: 271 NW 16TH STREET
City: POMPANO BEACH State: FL
Zip Code: 33060 Fax: 954-946-4076
Phone No. 954-946-6532 OFFICE 954-444-2561 CELL
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: WEEZERELECTRIC@ATT.NE:T
State or County License: EC0001360
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: AMEC
MORTGAGE COMPANY: _ Not Applicable
Name: NA
Address:
Address: 1075 BIG SHANTY ROAD
City: KENNESAW State: GA
Zip: 30144 Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: NA
BONDING COMPANY: Not Applicable
Name: NA
Address:
City:
Address:
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; your Notice of Commencement.
Signature of Own r/L see/Contractor as Agent for Owner
s
S
Signatur4lof ontractor/License Holder
STATE OF FLORIDAwSTATE OF
_ FLORI�p(�AA
COUNTY OF Tl'l�lW 'g COUNTY OF
The forgoing instrument was acknowledged efore me
this day of ��� 20 Uby
I
THOMAS P. JEFFEnS
(Namof per on acknowledging )
(Si alre of Notary Public- State of Florida )
Personally Known OR Produced Identt''f/'cation\
Type of Identification Produced I,A(ag` i
The forgoing instrument was acknowledged before me
this day of 20 n by
THOMAS P. JEFFERS
(Name of person' acknowledging)
(Signature of o ar lic- State of Florida )
Personally Known OR Produced Identification_
Type of Identification Produced_) uekj'�
Commission No.a Commission No.
t o (S f RESA P. LUNA
Notary Public - State of Florida
Revised 07/15/204 `%F°'' Commission SV FF 133083
TER1�A! P. LUNA
Notary Public - State of Florida
Commission N FF 133083
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