HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9/1512017 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 Commercial Residential xxxx
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: Savanna-Club-plat one-blk 2 1ot21 (or 1540-1949: 3452-7)
Property Tax ID #: 3425-701-0065-000-9 Lot No.
Site Plan Name: Block No.
Project Name: Sinko Fres,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
like for like panel replacement 150 amp new ground rod.
CONSTRUCTION INFORMATION:
Additional work to be er orme un er t is permit — c ec a app y:
11_HVAC Gas Tank 0Gas Piping Shutters Windows Doors
a
j�
LJ Electric Q Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: 5FtFtj, of First Floor:
Cost of Construction: $ 2480.00 Utilities: uSewer 0Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address:
Company: My Electrician, Inc
City: State.-FL
Address: 750 NW Enterprise Drive
Zip Code: 34952 Fax:
City: State: FL
Phone No. 772-873-5504
Zip Code: 34986 Fax:
E-Mail:
Phone No. 772-878-3974
Fill in fee simple Title Holder on next page ( if different
E-Mail:
State or County License: Le- 13 C-1 Qui
from the Owner listed above)
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
� Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Add reSs:75� NW Enterprise Drive
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 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
commencingwork or recordingour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner �" i ure of Cont actor/License Halder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFSTI�-�F COUNTY OFSA��..
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 15 day of $epi , 20_ by this 15 day of sept , 20 by
Name of person making statement Name of person making statement
Personally Known -xxx OR Produced identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
{signature of Notary Publ;`-r late of Florida ;��o (signature of Notary Public- 5=� a GC�Imi:SSiW1#
Commission No. ��'�u � li Feb, $
Cam�� Commission No. �$ ,
Expjll'�5: Fere. 9, ' Son. .rev Aacan No
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETE
Rev_ 8/2/17
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