HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: �� � Permit Number: D I o s o 3
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CE
Building Permit Application REIVED
Planning and LleveloomertServices JAN 2 3 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST, Jude C n
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential ty, Permitting
1 PERMIT APPLICATION FOR: Electrical El
PROPOSED INPROVENIENT LOCATION:'
Address: —v:- �. _
Legal Description: 61
Property Tax ID#: 1301-1'11-0001-00015 ? ( Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: RighSide: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace meter center with a combo pack at each address
CONSTRUCTION INFORMATION!:
Additional work to be nerformed under this permit—check all appy:
11 HVAC Gas Tank Gas Piping _Shutters Windows/Doors
ZElectric ❑ PLimbing Sprinklers Generator Roof
Total Sq.Ft of Construc=ion: 5Ft. of First Floor:
Cost of Construction:$ % e G�, 'go Utilities 1:1Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Wynne Building Corp. Name: James W Law
1 Address: 8000 S US#1 Suite 402 Company: Laws Electric, Inc.
j City: Po-t St. Lucie State: FL Address: 218 Beach Avenue
Zip Code: 34952 Fax: City: Port St. Lucie State: FL
Phone yo. 772-878-5513 Zip Code: 34952 Fax: 772-678-3347
E-Mail: Phone No.
772-971-4512
Fill in fee simple Title Hold 2r on next page(if different E-Mail: lawselectricinc@aol.com
from the Owner listed above) State or County License: ER0000122
1f value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNERIENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
Cit}- State: City- State:
Zp: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: r,/(dot Applicable BONDING COMPANY: a/Not Applicable
Name: Name:
Address: Address:
City: City:
Zp: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permitto 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 Count�yy 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 wit»ti)e 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 norr-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 most be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Si ature of Owner/Agent/Lessee igriature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA 4
COUNTY OF ST- LUCIE COUNTY OF ST. LUCIE
Tne forgoing instrument was acknowledged.before me The forgoing instrument was acknowledged before me
this :�clay of 2OZ by I this-. day of
r
.JAMES W LAW JAMES W LAW
piame of person aftco}edging) (Name of per1or+2'CklF�Usledging)
(Sigri f�NtayPublic-State or`Florida} (Signa ,of Notary Public-State of Florida}
Personally Known '✓, OR Produced Identification Personally Known ✓ OR Produced Identification
Type of identification Produced Type of Identific2tion Prodrrued
Juhef Law
Commission No_ C G d` 7 � (S NOTARY P �gtnmission►vo. M101 , PUBIC
STATE OF LOR!QA STATE OF FLORIDA
Revised 07115/2014 Expires 11/13/2020
Expires 11!1312020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW RMEW REVIEW REVIEW REVIEW REVIEW
DINE
RECEIVED
DATE
CGMPLETED
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