HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o2Old Permit Number: V$d a_da53
Building Permit Application
Plonning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-7553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Electrical 1`J
PROPOSED INPROVEMENT LOCATION:
Address: ^
Legal Description:
Property Tax ID##: 130k111-0001-0001 d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace meter center with a combo pack
CONSTRUCTION INFORMATION:
ACCUTIonal work toe e Orme under this permit—check a appy:
0HVAC El Gas Tanlc DGas Piping _Shutters a Windows/Doors
ZElectric 0 Plumbing OSprinkfers E Generator 13 Roof
Total Sq. Ft of Construction: S Ft_of First Floor:
I Cost of Construction:$ ��JC� • C�d Utilities:Sewer I n(Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Wynne Building Corp_ Name: James W Law
Address: 8000 S US#1 Suite 402 Company: Law's Electric, Inc.
City_ Port SL Lucie State:FL Address: 218 Beach Avenue
Zip Code: 34952 Fax: City: Port St_Lucie State: FL,
PhoneNo. 772-878-5513 Zip Code: 34952 Fax: 772-878-3347
E-Mail: Phone No. 772-971-4512
Fill in fee simple Title Holder on next page(if different E-Mail: lawselectricinc@aol.com
from the Owner listed above) State or County License: ER0000122
)f value of construction is$2500 or more,a RECORDED Notice of Commencement is required_ ]
8-d -89Z�-1,99-699 Lb££8L8ZLLMVl eZZ:60 86 Z6 Ged
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: r 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 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 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 Assodatibn 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,
accessorystructures,swimming pools,fences,walls,signs,screen rooms and accessory usesto another non-residential use
WARNING TO OWNER:Yourfailure to Record a Nodce of Cornmencernent 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.
s- ature of Owner/Agent/Lessee Wnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST- LUC1E COUNTY OF ST. LUCIE
The forgoing instrument wms acknowledged before me The forgoing instrument was acknowledged before me
this Z-2 day of � . . 20f ;by this 1�day of � i .2Oj&_0by
JAMES W LAW JAMES W LAW
(Name of person ackw=Gedging l (Name of person a'`ettrto*ledging)
{5ignat ire-61' Notary Public-State of Florida) (Signature Notary Public-State of Florida_)
Personally Known '✓ OR Produced identification Personally Known '✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.Git" Law Commission ivo.15—_G�44,Z:& (Seal)
NOTARY PUSLI A*W Law
F FLORIpA ARY PUBLIC
Revised 07/15/2014 e C0fW#OM46735 STATE OF
Expires t III rign
Comte�FLORIAA
p res 1/1 020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE M GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE .
RECENED
DATE
COMPLETED
t,'d L8ZLLMb� eZZ:60 81, Z6 qe�