HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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COUNTY
Building Permit Application Juni 1
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Planning and Development Services PliItt,AB bepa
Building and Code Regulation DivisionIltLucle Coulee(
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Electrical 0
PROPOSED IMPROVEMENT LOCATION:
Address: 1207 Fleetwood Lane Fort Pierce FL 34982
Legal Description: Driftwood Manor Section 1
Property Tax ID#: 3404-806-0016-000-8 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK: "L
install 120v 20 amp dedicated GFCI circuit
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit—check all- apply:
❑HVAC Gas Tank Gas Piping Shutters ❑Windows/Doors
0 Electric Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
00
Cost of Construction:$ DO Utilities: Sewer ili Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
NameBetty Sanford Name: Walter Nasi
Address:1207 Fleetwood Lane Company: Sol Electric LLC
City: Fort Pierce State:F Address: 5500 sw 43 terr
Zip Code: 34982 Fax: City: FT lauderdale State:FL
Phone No.772-272-8665 Zip Code: 33314 Fax:
E-Mail: Phone No. 754 423-4105
Fill in fee simple Title Holder on next page(if different E-Mail: wnasi72@yahoo.com
from the Owner listed above) State or County License: EC13008044
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:Betty Sanford Name:Walter Nasi
Address:1207 Fleetwood Lane Fort Pierce FL 34982 Address: 1207 Fleetwood Lane
City: Fort Pierce State: City: Fr lauderdale State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:5500 sw43 terr 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 your Notice of•Commencement.
--aA,ir . 44 A
Signature of /r:
ner/Lessee •ntractor as Agent for Owner g atur- o ontractor/License Holder
STATE OF F ' 43L{h STATE/A OF FLORIDA Zc/4�
COUNTY OF �jj COUNTY OF
Thef r oing instrume t was acknowledg�yed efore me The fogging instrume t was acknowledged be re me
this 3 day of / ,20x_ by this day of 7 e_ ,20 by
L-x-3- . 4 Mr"---6--- -m w 4 4.7-EF___ ly15.1""
Nam y
f person aking statement Name of person making statement
Personally Kno / :' Produced Identification Personally Kno. • - OR Produced Identification
Type of Ide Ification Type of I. tification
Produced 2.--e-- Produ -d v/e_
(Signature • •lic- tate of Florida) (Signet . :'��" �r1:7A7/ 7:7r„404
i 1f�.r'?►?"��K
r 44 0.4 --� r►,.Y COMMISSION#GG04[L9c¢422
t KATHR ^ EXPIRES November 21,21T2�
Commission No. 4% al�®CKER Commi sioff . a
y;r MY COMMISSION#GG049422
^Foy e EXPIRES November 21,2020
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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
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