HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
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: To Select from dropbox, click arrow at the end of line
PROPORENEW
Address: 7003 S Indian River Dr
Legal Description: 3412-502-0008-000-1
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Building permit is applied for 1802-0039. Need to have a seperate permit to remove existing meter
from house and install temporary power pole.
tJCT10N INS - ;
dtona worrK to e er orme un er t is perms —c ec a appy:
❑HVAC �GasTank []Ga Piping _Shutters ❑Windows/Doors
U Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof ❑ Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 500.00 Utilities.
❑Septic Building Height:
Name Daniel Fitzpatrick Name: Blair Kaluahine
Address: 17357 89th PI N Company: Electrical FX Inc
City: Loxahatchee State:FL Address: 12895 88th PI N
Zip Code: 33470 Fax: City: West Palm Beach State: FL
Phone No.561-793-9511 Zip Code: 33412 Fax:
E-Maik Phone No. 561-262-9431
Fill in fee simple Title Holder on next page (if different E -Mail: blair@electricalfx.com
from the Owner listed above) State or County License: EC13007991
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Blair Kaluahine Name: Blair Kaluahine
Address: 7003 S Indian River Dr Address: 12895 88th pi n
City: West Palm Beach State: City: West Palm Beach State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: 1289588th pl n
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
Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which is in conflict with any applicable
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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COU NTY OF Palm Beach
COUNTY OF Palm Beach
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 5th day of April 20 /e by
this 5th day of April 20/$ by
to) Jy., KG.it;s hi '
Name of personing statement
Name of perso aking statement
Personally Known �' OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Si nature of Notary
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pYP A ARTUSCEL�I
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(Signature of Notary
" MARTIN MARTUSCELLI
Commission No.
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Commission No.
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Commiss on GG 188128
%'ForF��f� My Commis®Ion Expirlas
February 20, 2022
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February 20, 2022
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Rev. 8/2/17