HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:Xlk,tel" 0,40
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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 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 80 BLVD
Legal Description: ,
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
-DETAILED DESCRIPTION OF WORK:
Pipe in 100 amp service( 11/4 pipe, 3)#3,  ground THHN wire)from pedestal. replace 100 amp
main lug panel in mobile home.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—cleck all appy:
HVAC _Gas Tank ❑Gas Piping Shutters Q Windows/Doors
aElectric 0 Plumbing Sprinklers ElGenerator E] Roof Roof pitch
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Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 2450.00 Utilities:n Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:;!
Name Cara Smith Name: Robert Thompson
Address:80 Mettows Blvd Company: R.Thompson Electric
City: Jensen Beach State:FL Address: 439 SE Cork Rd
Zip Code: Fax: City: Port St Lucie i State:FL
Phone No.(615)856-5622 Zip Code: 34984 Fax:
E-Mail:Jcjcsmith@aol.com Phone No. 772-342-2064
Fill in fee simple Title Holder on next page(if different E-Mail: sparks9634@aol.com
from the Owner listed above) State or County License: EC13007306
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: J
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 the permit 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.
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Speure of Owner/Lei r as Agent for Owner Sign o Con een a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this k day of 20 Eby this day of ,20 by
(Name of person acknowledging) (Name of person acknowledging)
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Sig ature of Notary Publ -State of Florida) Si at re o Notary Public-St, a of Florida)
Personally Known OR Produced Identification Personally Known ORiProduced Identification
Type of Identification Produced Type of Identification Produced
- �a •1 I tea,a ,
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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