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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: � Permit Number: i LAUG202018 RECEIVED DullulllsrClllilLMIJFJII1.dl.IUIIPlanning and Development ServicesBuilding and Code Regulation Division cie County, Permitting 2300 Virginia Avenue,Fort Pierce FL 34982 -" Phone: (772)462-1553 .Fax: (772)462-1578 Commercial Residential YES PERMIT APPLICATION FOR: Electrical PRO".POSED IIV(PROV'MENnT LOCATION' Address: 112 N. Las Olas dr Jensen Beach FI. 34957 Legal Description: Property Tax ID##: �J I "�t�" �L) C9 ' 0©© - I Lot No. Site Plan Name: Block No. Project Name: Fnehofer Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTLON OF WORK F Install new and upgrade servicee �b6�aLt�J U CONSTRUCTIOtINFORMATION O , Additional work to be erformed under this permit—check all apply: E1HVAC Il Gas Tank []Gas Piping Shutters ❑Windows/Doors i Electric ❑ Plumbing OSprinklers F Generator E] Roof Roof pitch t i Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ $3000.00 Utilities: _Sewer L__ISeptic Building Height: I y OWNER//LESSEE u ;; CONTRACTOR 2�3:FoQ(tia.�ToTl ow�5 r Address: //2 A)- Company: Dreamworks Electrical Services t City:cJy�J5er'i State: Address: //P �0, fAzWte&g LP Sl'� Zip Code: Fax: City: State:fl Phone No. 541-373- C/_7 7 b4AUUA Zip Code: Fax: E-Mail: Phone No. 561-602-0244 Fill in fee simple Title Holder on next page(if different E-Mail: chris@dreamremodel.net from the Owner listed above) State or County License: EC13006545 It value of construction is X2500 or more,a RECORDED Notice of Commencement is required. ' 1 SUPPLEiVIENTAL CONSTRUCTION LIEN LAVU INFORMATION :` DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name Name: Address:112N:Las Olas dr Jensen Beach Fl.34957 Address: City: State: City: State: Zi'p: Phone Zip: Phone: I FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not 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. StAucie 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 renuested.permit.I do herebv agree that l 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 hnfnrn+ho fire+ inenne-+ie+n If v1n1I intnnrl+r%^k+-jin fin �nnef dt AA+k lonAor nr on n++nrnn+a hnfr,rn YVIV\\. L1 It- III JI 11IJI.IVr•I VI\. rVN \It\.\If.\ LV VN141f1 f111V\ft.\IIb, •.Vf IJ\.fll tlI\.II IVfIVl.1 Vt Y\1 U<lV\Ilb.r VVIVI\. commencing work or rocording your Notice of Commencement. S' nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDASTATE OF FLORIDA COUNTY OF LU�,�, COUNTY OF The for oing instr'ment was acknowledge before me The for oing instrum nt was acknowledgebefore me thlsC day of 20-4 by this day of 20 by I � � I 1 7� Name of pe son making statement Name of person aking statement Personally Known OR Produced Identification� Personally Known OR Produced Identification Type of Identific tion Type of Identificat Produced Produced I i LD-AA 4.0• Ca — ((Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida I AREN S. NIELSE �� PY Fv'� Commission N Commission No. ;o�� ��;S @�II)Florida-Notery Pu li ;=o• "''�;� EN S. NIELSEN •= Commission # GG 2074 4 `F;State of Florida-Votary Public My Cornmission Expires '= Commission #GG 20748 '' of June 12, 2022 1y Pv` 41ni\A l ��.IFFfii- mission Expires REVIEWS ung 022 RVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW R IEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED PL'DATE 'COMPLETED Rev.8/2/17