HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A\1''S\,� Permit Number:
EAUG
CEIVED
Building Permit Applicatio 13 201Planning and Development ServicesBuilding and Code Regulation Division County, Permittitt�
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: ElectricalEL
PROPOSED IMPROVEMENT LOCATION:
Address: 4751 S Indian River Dr
Legal Description: 36 35 40 From Int of E LI of Fear and N Li of Elko S/d,Th Run Nwly on RR 75 Ft for POB.The E to Riv,Th Nwly ALG Riv 108 ft
Th WLY 340 FT to RR,TH Sely ALG RR to POB-with Rip RTS-Less, RD.
Property Tax ID#: 2436-331-0006-000-4 Lot No.
Site Plan Name: Block No.
Project Name: Curtis
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Wire and install 80 AM pool panel behind existing house panel
CONSTRUCTION INFORMATION:
Acid itiona I work to be nertormed under tispermit—check all appy:
HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
Electric 0 Plumbing ❑Sprinklers E Generator F] Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1000.00 Utilities: Ln�Sewer I Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Willaim Curtis Name: Robert Thompson
Address:4751 N Indian River Dr Company: R Thompson Electric
City: Fort Pierce State: FL Address: 439 SE Cork Rd
Zip Code: 34982 Fax: City: Port St Lucie State: FL
Phone No.636-614-8971 Zip Code: 34983 Fax:
E-Mail: Phone No. 772-203-1756
Fill in fee simple Title Holder on next page(if different E-Mail: Rthompsonelect(c@yahoo.com
from the Owner listed above) State or County License: EC13007306
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
N a m e:willaim cures Name:Robert Thompson
Address:4751 S Indian River Dr Address: 4751 N Indian River Dr
City: Fort Pierce State: City: Port St Lucie State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:439 SE cork Rd 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 our Notice of Commencement.
Slgnat re of. ner/Lessee/Contractor as Agent for Owner Signaturg&Contractor/License Holder
STATE OF FLOR14A. STATE OF FLORID
COUNTY OF COUNTY OF
The forgoing instrument was acknowled ed before me The forgoing instrument wa acknowledg before me
this day of 20% by this day of - 20 by
_N0q
Name of person making statement Name of p rson making statement
Personally Known_)Q OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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