HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierre FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:.---
Address 400' Gy—G'Q.YIIWOOd -'�V.
--------------
Legal Description: (ret nw000( QIK I L-b -31 (N33A(A
( CAI
Property Tax ID #: 247-1 - Z 02 - 003 - 01130-`i
Lot No.
Site Plan Name:
Block No. t
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
Q,celacc, ex►�+;,� '�-p4,gSc. 200 /vtc-1-e,(-
Soc,14,01 Cha Ser,J;c.�- w.c�cF.
rxrc}�n5 ►04J Cev►}-•.n *o rr_mq %. (Zealv;r,e>
Sctvv) Y-ofcycor"ccfle-dconnC4.
3 -pvr-s" 1W/-&10V DC'1+a
CONSTRUCTION INFORMATION:
AaditionaT-workto be�jerftormed under this permit - check
ail -apply:
HVAC L_I Gas Tank F]Gas Piping
1:1_ Shutters Windows/Doors
[ J Electric ❑ Plumbing Sprinklers
L1 Generator Roof Roof pitch
Total Sq. Ft of Construction:
SFt. of First Floor:
D
Cost of Construction: $ 1,200 Utilities:cn
Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameL%scA yi„swtoh,
Name: lr�g,rizy ��r►,gnn
Address: �AO(PL brtev%wOOu Or.
Company:
Address: _'U1 NVJ MercGn}:1e- Pl. A* 103
City: tori Pcercc, State: FL-
City: ' 4A: Por>r S+• t-uc ,,- State: e(_
Zip Code: 3`i Ci,6-z' Fax:
Phone No.
Zip Code: 3yC1 $(6 Fax: 772-421- R1 &14
E-Mail:
Phone No.—I'7'E.- (,2I • °I4rty
Fill in fee simple Title Holder on next page ( if different
E-Mail: b e,1kyie+Vi tr . el eL}-r; c ei q rti,tii �. GoM
State or County License: CC. [3004122
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of
Commencement is required.
St}RK _i 9PiT>ak 4 Ns ll+ i' } N k 1NF''URMAITt QN:'
Name: _
Address:
City: _
Zip:
ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State
Not Applicable
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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
orethg,e first inspection. If you intend to obtain financinspnsult with lender or an attorney before
co encing work or recording your Notice of Commencoherit.
ature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The fgrgoing instrument was ackn wledged before me
this�d`�(-T
ayof (UR�Z_, 20 L_ -16y
1
( me o rson acknowled n )
(Signa ure of Notary Public- t90
rida )
Personally Known OR Produced Identification
Type of Identification
,t •s;: DAVID JURKIEWICZ
Commission No. `: My
CO�ION # FF998909
EXPIRES June 05, 2020
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged efore me
this Z- day of ()CtDg�SZ— , 20 by
Nam f person acknowle I g )
(Signature of Notary Publi - St to f Florida )
Personally Known" AA -4 IrlQntifirptonn
Type of Identifica q ed DAVID JU
`= MY COMMISSIONFF998909
Commission No. s� •. XPIRES J�r�e 5, 2020
(407) 398.0153 FloriclallotaryService.com
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INITIALS
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