HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
r
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 El
PROPOSED IMPROVEMENT LOCATION:
Address: 122 Laidbaek. Way, Fort Pierce, FL (duplex)
Legal Description: Jay Gardens-Ft Pierce Bl_K 6 S 19.25 Ft lot 36 and all lot 37(0.23 AC)(OR 395-948;996-466;1213-1321;3990-2525)
Property Tax ID#: 2311-601-0122-000-7
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove existing and replace with new 100 amp electrical panel
CONSTRUCTION INFORMATION:
itiona war to e er orme under tins permit—check all app y:
0HVAC Gas Tank E]Gas Piping In Shutters Windows/Doors
R]Electric ❑Plumbing Sprinklers OGenerator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ 750.00 Utilities: ❑Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Gorman Properties of 5LC LLC Name: Michael Dale Ault
Address:1209 e�aware Avp Company. Ault Brothers, Inc. Electrical Contractor
City: Fort Pierce State:FL Address: PO Box 1528
Zip Code: 34950 Fax:
City: Port Salerno 5tate:FL
Phone No. Zip Code: 34992 Fax: 772-283-0321
E-Mail: Phone No. 772-283-5520
Fill in fee simple Title Holder on next page( if different E-Mail: aultbros@yahoo.com
from the Owner listed above) State or County License: ECO001693
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x 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 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
commencing work or recording our Notice of Commencement.
eLk't-_
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF MC.r4 i n
The forgoing instrument was acknowledged before me The forgoing .2ye acknowledged before me
this day of 20_ by this 3L day of _ Q-tnyay--U 20 LV 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
(Signature of Notary Public-State of Florida) (Signature of NQtary Public-
a THOMAS E HILL
Commission No. (Seal) Commissi r£ f :: �Y�AiV4�A5fitON#FA#44
EXPIRES February 09,2019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17