HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i 01� ®�Q
Date: 8/29/2017 Permit Number: 1706=0247
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 X
PERMIT APPLICATION FOR: Electrical
PROPOSED.IMPROVEMENT LOCATION:
Address: 5010 Palmetto
Legal Description:
Property Tax ID#: moo_ 6QV•C�ld� c/(Xl� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: l
DETAILED DESCRIPTION OF WORK:
Temperary power pole
;CONSTRUCTION INFORMATION:
Additional wor to Ifertormed under this permit—check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑±Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch-
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 3Z Utilities. Sewer Septic Building,Height:
;OWNER/LESSE'E:. CONTRACTOR
` Brian Helseth ?`Lawrence Stubbs
Name_ Name:'
Address:5010 palmetto ` pC�ompany: S&W Electric,Inc
r City Ft Pierce �,. State FL `Address 501 West;Coker Road. .,
Zip Code: Fax: City: Ft.Pierce"," ` State:FL
Phone No. Zip Code: 34945 Fax: 464-4273
E-Mail: Phone No. 464-6466
Fill in fee simple Title Holder on next page(if different E-Mail: stuboutelectric@aol.com
from the Owner listed above) State or County License: 29442
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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: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 Counter 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 wit lender or an attorney before
commenciggLyork or recording our Ptice of Commencement.
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nature of Owner/Lessee/Contractor as Agent for Owner OF,19ture of Contra ctor/L cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 COUNTY OF
Theo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
Thi day ofa 20 f1by thi day of 20 0�by
(Nam o rson acknowledging (Name of person acknowledging)
( ' ature of Notary Public-Stat o orida) (Signa ure of Notary Public-Stat of Florida)
Personally Known OR Produced IdentificationPersonally Known R ro u d Identification
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW. REVIEW - REVIEW
DATE
COMPLETE
INITIALS