HomeMy WebLinkAboutBuilding Permit Application I
ALL=APPLICAABLE INFO MUST BE•COMPLE`TED FOR APPLI 71C1N TO BE ACCEPTED e {� - 12
Date: !' s-100 PermitNftrb j o t9
Ya SJrt: RECEPT'
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Building Permit Applicatio; APR 3,0 2018
Planning and.Development Services i
Building.and Code Regulation.Division Permitting Department
2300,Virginia Avenue;Fort Pierce FL 34982 S U ,County, FL
Phone:(77 )462-T553 Fax:(772)"46,2-1578: Corn ercial
PERMIT APPLICATION FOR: Electrical
_� as "4 - x -�$ - :. .4 h '�.� {. - » x a•.. � a r.r.,ti �+ ..; s 't.ti;
Address: 6038 Inddo Road 7
Legal Description: INDIAN PINES VILLAGE-.BLDG S UNIT A.D"PRO-RATA SHARE.IN�c,G0iV1MQN ELEMENTS{UR 3960 1537)
Property Tax ID.#c 1313-501-0141-000-2 Lot No;
Site Plan Name: Block No.
Project Name:
Setbacks Front Back-: Right Side Left Side:
Repia'ce 11J0-arnp pane! alike for like.) existing.mete
,xt" pr"f, Cry t. i t 7c, tr .a
A itiona- wor_:to (ele orme un er t is.permit--a ec;"a t appy;
HVAC U Gas Tank Gas-Piping _Shutters, i windows/Doors
L'J Electric Plumbing ❑5prinkJers1:1Generator (�Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First[nFl�oor:
Cost of Constructiion:S.2,000,00 Utiliti. s:oSewer F]Septic Building Height:
( WNEft�LESSEE � __ r � r °CQN=TftACT }Rx `, M
" x
Name Johnna Wallace Name:
Address:2251.SE Mandrake Cir Company Elite,Electric and Air, Inc
City: Port St Lueie State:F� Address: 1691 SW South W cedo.'-Blvd
Zip Code: 34952 Fax: City:. Port St Lucie State;FL
Phone No:772-233-3594 Zip Code: 34984 Fak:
E-Mail: Phone No. 772-340-3797
Fill in feesimple Title Holder on,next page(if different E-mail: karen@eliteeiectricandair:com
from•:the.Owner listed above) State or County License: EC43006036
If value=of'construction is$2500 or.more,a RECORDED Notite:oti]6-mr'nL-"!':e'rnent,'s required.
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SUtRRM` ENTAL�COIVSTRUC I"IO'N`LiEiN LAYN,JNFO`RMATIQN` x uh
2s
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY _Not Applicable
N a me:.Johnna Wallace Name.
Address:6038lnd6okoad 7 Address: 2251$EMandrP or
City BortSt Lucie State: Cit
Y: Pod St Lucle State:
Zip: Phone Zip: Phone:
FEESIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: N.ot.:Applicable
Name Name:
Add ress:169:1 swsouth macedo Blvd Address:
City: City:
i I
Zip: Phone: :Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby. ade'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.perm t-will authorize thepermit holder=to build the subject structure
which is in conflict with any applicable Home Owners Association rule's,.bylaws or ancovenantsthat may restrict or prohibit such
structure.Please.consult with your:Home Owners Association an review your deed for anyrestrictions 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 Code and St.Lucie County Amendments.
The following building.permit applications ire exempt from unde going<a full concurrency review room additions,
accessory structures,swimming pools,fenceswalls signs,screen rooms and accessory usesitd:anoth'er non-residential use
WARNING TO OWNER:Your failure to Record a Notice;o f Commencement may result in your.paying twtae.for
improvements to your property.:A Notice:of.Commen ement must be-recorded an',d posted on the joLsite
before.the firstinspection: If you intend to obtain flea cing,consult with lender orae attorneybefgre
co.mmencin .workorrecording your Noticeof"CornmehComeht.
Sign atureM Ow Lessee/Contractor as Agent for'Owner Signature o Co ract r/License Holder
STATE OF FLORIDA STATE OF.FLORIDA
COUNTY OF A Ltic i COUNTY OF ST -LAX-U4-
The forgoing instrument was acknowledged before me The forgoing instrumentwas acknowledged before me
this. day of R�\ 20l$'by this' of PrPf�:�� 20�by
al.n Pa nitcta.`L t��n c\ 1�• Ptyciy Pc4L,
Name of person making statement Name o`f'person!making,statement
Personally Known OR Prod uced.ldentification Personally Known'X OR.P'roduced'ldentificafion
Type:of Identification Type of Identification
Produced Produced
(Signature of olary Public-State of Florida) . (Signature of Notar
er'n` Lc KAREN.BENNETT
.Notar P
Commission ° gyp yKAREN BhjT Commission No: �2+ ; Y ob(L6e�l�te'of1
Public• tS ate 61]02
• Comm ssion .FF 970.
?•. • c Commission FF 97nr o� '
, FLOP Mx Comm,Expires J.un 2''
s,,r PP My Comm,Expires Jun 2 "!^ " Bon
''c!nm" Bonde through NationaCryr
REVIEWS VISOR. PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW 'REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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