HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETEDTOR APPLICATION TO BE-ACCEPTED
11/9/2017
Date: Permit Number: ;
_ .
• WN am
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: 4200 N.HWYAIA.UNIT#311 ,
Legal Description:
Property Tax ID#: 1423-501-0115-000-9 Lot No.
Site Plan Name: Block No.'
Project Name•:
Setbacks Front' Back: Right Side:' Left Side:
DETAILED DESCRIPTION OF WORK:
REPLACE EXISTING MAIM LUG ONLY,
20-SPACE PANEL INSIDE CONDO & REVERSE TO FACE HALLWAY
(currently is inside kitchen cabinet), `
CONSTRUCTION INFORMATION:
Additional work toe e orme un er this permit—check a apply:,. r
HVAC Gas Tank ' ❑Gas Piping _Shutters 0 Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq-Ft.of First Floor:
.Cost of Construction:$ 1,200.00 Utilities:Sewer Septic I' Building Height: >
OWNERAESSEE: ..-, ,,CONTRACTOR:
BARBARA CAS I a a`r.• k'
Name ..
Address: acs "Compariy:',L)H �.,.
F :.�.. .%z..
City. •-State: Address•..: •-, ^1,.. .
L.
Zip-Code: Fax:49 City: PO State:
Phone No. Zip Code: 34983 Fax:X71-979'!622_
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: 6114CJ16W5 C+�BELI.SOU7?!•NC7
from the Owner listed above) State or County License: - =
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'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:
OWNER/CONTRACTORAFFIDVIT: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
commeMing work or recording our Notice of Commencement. '
igna re bofownerTLessee/Contractor as nt for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �T. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this_day of 20_ by
�U lt�I inn C+tCLU S ; , - � . ,
Name of pe s n making statement Name of person making statement
Personally Known OR Produced Identification. Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
�i
ignature of N"ryPub6lri,8�'-State o I r'd ) e of Notary Public-State of FloridaCommission No =off" ) Notary Public State Commis n.No. (Seal)
Tracey Commission
)U�� 1a My Commission FF 71067
1
OF�d" Expires 04/2612020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
;COUNTER- REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev:8/2/17
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:
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 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 with lender or an attorney.before
cornmencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTY OF ST. LuCle
The forgoing instrument was acknowledged before me The forgoing instrument.was acknowledged before me
this_day of 120 by this'� I� day of 20_ by
Name of person making statement Name of.person making statement
Personally Known OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Au d)A—
(Signature of Notary Public-State of Florida) (Signature of N ary Public-State of Florida')
�blie State of Florida
Commission No. (Seal) Commission No _ Y��F scola
T�a-cey M is stat
" My Commission FF.971067
Expires 04/2612020
REVIEWS FRONT ZONING.. SUPERVISOR PLANS VEGETATION SEA TURTLE- MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17