HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:\< IAm 1 11 Permit Number:
Building Permit Applicatio
RECEIVED
Planning and Development Services OCT 4 Z��7
Building and Code Regulation Division 2
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CommercialRAffoRitling�partment
PERMIT APPLICATION FOR: Electrical St. Lucie County,
PROPOSED"MPROVEMENTLOCATION:`
Address: -76,-7' We�CPora Wa,r �or� S� lwci� , �(� '1406
Legal Description: Lo+ Iq. { 00- 543 -2&06p)
Property Tax ID#: 33Z1 - $Ol ' bplq - 000•Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
3 `
DETAILED DESCRIPTION OF WORK:
1-�SFa6l 'j,OAr ,p (2FFr &V_- �or S�?J .'C' SYJ-eo,
CONSTRUCTION 1:NFORMATI_ IN.
Additional work to be nertormed under t ispermit—check all apply:
HVAC Gas Tank 0Gas Piping _Shutters Windows/Doors
IBJ Electric
Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ 3(�O UtilitiesliSewer Septic Building Height:
OWNER/LESSEE y ;;CONTRACTOR '.,
Name A. D AyJall 5-e fA Name: Gharlts Mowrn
Address:"7(,75 I,Jcr&m4 W2tA Company: �ellwe�i�cr t►[�{r;� Lo�,L��
City: L_Vc'i<, State:j-L Address: 'S7i Al W M erca�o-�'Jc �f 41 o3
Zip Code: 3` q g6 Fax: City: Nl+ Sf. LLuc."' State:i(,
Phone No. Zip Code: 3 t4CL$(, Fax:
E-Mail: Phone No. 7,7t_ 6-z, -614ay
Fill in fee simple Title Holder on next page(if different E-Mail:bell W c!-1� elca{ric F�Gw�a;) t7+h
from the Owner listed above) State or County License: Cc-ISOOq I zL ^'
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN 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 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 1 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
More the first inspection. If you intend to obtain financin , nsult with lender or an attorney before
1corAMencing Workor recording our Notice of Comm enc enrn e rit.
� &44k 01
s
S`i6ature of Owner/Lessee/Contractor as Agent for Owner Sig re of Contractor/License Holder
STATE OF FLORIC7,DA rr I' � STATE OF FLORIDA
COUNTY OF VLtCc �- COUNTY OF S'i• (.,t ie_(
J -f_
The�Q r oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Gday of (3C_-C. 20 aby this a day of OG'('• 20 [_+ by
1
(Name of person acknowl ing) (Name of person acknowledging)
)_V�j ��_ I
( • ure of Notary' / is-State of Florida) (Sign a of Notary P li to of Florida)
Personally Known ✓ OR Produced identification Personally Known_�OR Produced Identification
Type of Identification Produced Type of Identification Pr
DAVID JURKIEWICZ
•
QA VID JURKIEWI m ission No. '
Commission No. :aR' z (5"n `c MY COI§W&ION#FFM8909
MY COMMISSION#FF 8909 EXPIRES June 05,2020
ze.50.7 EXPIRES
(407)398-0153 FicrideNotaryServlce.com
Revised 07/15/2014
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