HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9-4-2018 Permit Number: ! W
• RECEIVED
Building Permit Application SEP 0 5 2015
Planning and Development Services
Buildingand Code Regulation Division Per t. Lucting Department
9 St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 3318 ORANGE AVE - LOT 67
Legal Description: 8 35 40 PART OF SE 1/4 OF NW 1/4 MPDAF: FROM INT W L1 ANGLE RD AND NL1 OF ORANGE AVE
AS SHOWN IN PL BK 7-12 RUN W ON N L1 ORANGE AVE
Property Tax ID#: 2408-243-0003-000-� Lot No.67
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
RESUPPORT EXISTING ELECTRICAL METER RACKS
CONSTRUCTION INFORMATION:
Additional work to be nerformed under t ispermit—check all appy:
11 HVAC Gas Tank Gas Piping Shutters a Windows/Doors
Electric ❑ Plumbing 11 Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 950.00 Utilities:cn Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name CIO RIVERSTONE COMMUNITIES Name: JEFFREY R. WAITE
Address: 6400 TFI FcgAPH Rn, STF Ino Company: INFINITY ELECTRIC CO., INC.
City: B OOMFIELD TOWNSHIP State: _AU Address: 630 TAI I PINES RD
Zip Code: 48301 Fax: City: HAVFRHII I State:FL
Phone No. Zip Code: 33415 Fax: 561-588-3805
E-Mail: Phone No. 561-662-9299
Fill in fee simple Title Holder on next page( if different E-Mail: INFINITYELECTRIC@BELLSOUTH.NET
from the Owner listed above) State or County License: EC13005456
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: y Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: _ Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _X_Not Applicable BONDING COMPANY: XNot 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 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.
0��_ -V'e 0'a, Z
Signatur n essee/ ontractor as Agent for Owner Sign atf on actor/Lic se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_41h day of September 20__1$by this_4th day of September. ,20_1$ by
JEFFREY R WAITE 1FFFRFY R WAITF
Name of person making statement Name of person making statement
Personally Known_�OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
I&,,, iC64�
(Signature of Notar)Public-State of Florida) (Signature of Not Public-State of Florida)
Commission
Commission --��
o. ffylN jU TICE ,,•L KEVIN JUSTICE
State of Florida-Notary Public =� =State of Florida-Notary Public
•c Commission#GG 249561 ` Commi
A Sion Expires '•., ,,`' Commission Exp res
REVIEWS RVISOR PLANS IQB22 MA GROVE
COUNTER REVIEW IEW REVIEW REVIEW IEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17