HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: 'o-. -/ Permit Number: i((G o -cio& I
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Electrical
-':'GY '::. 3titi"f £•..•51 .'ma I t- i .'M i ry. -;il3
PROPOSED IMPROVEMENT LOCATION :` , �X, 3 .a;
Address:
128 SE PRIMA VISTA BLVD,PORT ST LUCIE,FL 34983
Legal Description: RIVER PARK-UNIT 5 BLK 50 W 40 FTOF LOT 11 AND E 40 FT OF LOT 12(PARCEL G)(MAP 34/28N)(OR 3413-1730)
Property Tax ID#: 3 UIvot--51-(0— C)135 . 000- Lot No.11
Site Plan Name: Block No. 50
Project Name:
Setbacks front Back: Right Side: Left Side:
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DETAILED DESCRIPTION}:OF WORK t `" sr
SERVICE CHANGE-
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CONSTRUCTION INFORMATION ;° F
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Additional work to be erformed under this permit—check all;hall apply:
❑HVAC I Gas Tank Gas Piping Shutters ID Windows Doors
aElectric Plumbing Sprinklers El Generator El Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
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Cost of Construction:$ 00--jj 27t010.. v Utilities: Sewer Septic Building Height:
tONTRACTORj
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Name KARINA VARGAS Name:
Address: Company: MR.ELECTRIC OF PORT ST LUCIE
City: PORT ST LUCIE State: FL Address: P.O.BOX 880671
Zip Code: 34983 Fax: City: State:Fl-
Phone
LPhone No.772209-8168 Zip Code: 34988 Fax:
E Mall:mvargas0112@yahoo.com Phone No. 772-777-0939
Fill in fee simple Title Holder on next page(if different E-Mail: mr.electric.psl@gmail.com
from the Owner listed above) State or County License: ER13015179 COUNTY CERTIF#29955
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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•SUPPLEMENTAL.CONSTRUCTION LIEN LAW INFORMATIONE,- ' Y ..-1,',,,,-L.--,--x 1
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: KARINAVARGAS Name:
Address:128 NE PRIMA VISTA BLVD,PORT ST LUCIE,FL 34983 Address:
City: PORT ST LUCIE State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:P.o.Box880671 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. I
In consideration of the granting of this requested permit,1 do hereby agree that 1 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 reco dingnyour Notice of Commencement.
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Signature of Owner/Lessee/Contractor a•Agent f.'1 0°heel Signature of Contractor/License Holder •
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STATE OF FLORID —1 - #� STATE OF FLORI. ' - j
COUNTY OF ` !�, _ COUNTY OF �� I_'��: I =o,a
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The forgoing instr nt as acknowledgedbefore wiz_E The forgoing instru nt was acknowledged fore g Arc
thiT day of ,20i(i by Q 8°z this,'c day of ,20/�y ¢Yw g
MO r SSC nm . I d - 1 h °'
Name of person making statement a�'`' •
�';Z° ' Name of person making statement j•`�
y OR Produced .entificati•� '•• -wcg Personally Known • OR Produced Identificat h 1`:6':•
Type of Iden fica Q•n p- ;;azT' , Type of l entr :tin I I. * 3`�'' ,
Produced �� �/l� ” ” Produced A._! 1 ..
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OAd Wil, /
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(Signature of tary Public-State of Florida (Signature of No�j Public-State of Florida) f
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17