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HomeMy WebLinkAboutELECTRIC - RESIDENTIAL All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `` Date: Permit Number: ` of -0014 3"M06-0 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 1/ PERMIT APPLICATION FOR: PRdPOSED IN.PRO�IEN, ENT LOCATIaN: Address: / UG fi; Legal Description: Property Tax ID--#: 2W r 6e>3 Q Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED IT RE 1NORzK: C®NSTRl1CTl®N lN'FO n/IATION: Additional work to be pertormed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction: $ z Utilities: —Sewer —Septic Building Height: RM, NER/LESOSEE: CONTRACT®R: S s Name /II-T/.i2 r Name: ��--.r-•��-� IZ. » Address: e 04 3 .7 T �� Company: City; / i P I' Yee-c State: Address: P1 Zi Code: //11 Zip'Code: y Y Fax: City: �� f'1�rz^e State Phone No. 7 Z - `�z"e!�9 2 Zip Code: y 9 Y I Fax: E-Mail: Phone No 7 Z - Y Y,KG Fill in fee simple Title Holder on next page(if different E-Mail- from the Owner listed above) State or County License 9 Y Zi If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. L SUPPLEMENTAL CONSTRUCTI©N LIiEN LAW'IN4'RMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name:' - Address: ame:' -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 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 commencinjkwork or recording your Notice of Commencement. Signa ure o Owner/Lessee/Contractor as Agent for Owner aur o ontrac or/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OFCOUNTY OF �•�,c,_Q_, The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me this day of 20 t% by this day of 20—Z- by N of erson making statement. Name of person making statement. Personally Known OR Produced Identification Personally Know OR Produced Identification Type of Identification Type of Identification Produced Produced ISea'Fur-e of Notary Public 5 =)fir, JSignature of Notary Public-'State of Florida) ,2o�par"refs LASHAHNA INGRAM Commission No. ?. **�;;tS� l)arY Public-State of Fl, mission No. � (5eal)omm.Expires Dec 20, n' LASHAHNAINGRAM o, ` � � Commission ' ., :2* p�: Notary Public-State of Florida one I through National Plotar qs$ .' My Comm.Expires D ec 20,2018 •—�._ — REVIEWS FRONT ZONING SI;iPERVISO tar NS VEGE �o��SE�F ' fLE # FNIA�VCbR E Natioral Nc COUNTER REVIEW REVIEW REVIEW REVI- rljf(.�Qlll'___—_ RI3Vt DATE RECEIVED DATE COMPLETED ev.