HomeMy WebLinkAboutBuilding Permit Application ALL APFLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r���� =�,� o���� Permit Number: .
F,-
Building Permit ApplicationMj
Planning and Cleveloomert5ervices
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 iNPROVENIENT LOCATION:
Address:
Legal Descripti gin:
Property Tax ID#: 1301-1.11-0001-000/5 ? L Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Righ Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace meter center with a combo pack at each address
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check all that appy:
HVAC Gas Tank aGas Piping _Shutters ❑Windows/Doors
9Electric ❑ Plimbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ /� U Gy - U Utilities- Sewer aseptic 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.
i City: Po:t St. Lucie State: FL Address: 218 Beach Avenue
Zip Code: 34952 Fax: City: Port St. Lucie State: FL
Phone No. 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
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: vl 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 hi ilding nprmit applications are exempt from undergoing a 171.111 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.
Signature of Owner/Agent/Lessee S nature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST. LUCIE COUNTY OF ST. LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20Z by this -_&, day of _1�_k_
JAMES W LAW JAMES W LAW
(Name of person adknoullPdging) (Name of person aekno*ledging)
�
(Signature Notary Public-State of Florida] (Signature o Notary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produaed
Commission No_GGl����7 � I Juhet Law Commission ivo.U G/�c 7.-3 5 (Seal)
NOTARY pUBLI4, Juliet Law
F FLORI4 A NUTARy PUBLIC
Revised 07/15/2014wilo-Commit#GGOM735 STATE OF FLOR10A
Expires 11/18 m
Comp GG
xpires1/13/2p22pp
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED