HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUSTBECOMPLETED FOR APPLICATION TO BE ACCEPTED
Date 118 Permit Num
RECEIVED
Building Permit Applicatio DEC 112018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St L count
Y,(772)462-1553 Fax: (772)462-1578 Commercial Yr FL
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION: '
Address: TRANQUILITY/B�A�SE LANE PORT ST. LUCIE, FL.34987
Legal Descriptio a r0 �`-f�U R) lG J (fir J(� rl
rrM
3 �1 -8aI o0 6� c��o
Property Tax ID#: � Lot No. �
n
Site Plan Name: Block No.
Project Name: 0
3
Setbacks Front Back: Right Side: Left Side:
!y
DETAILED DESCRIPTION OF WORK:
SERVICE CHANGE �>'� b �-U �j m�'- O
d
c
CONSTRUCTION INFORMATION: :
ACIditional work toa nertormed under this permit—check all appy:
0.HVAC 0 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
M
n M
Electric 0 Plumbing Sprinklers Generator L Roof Roof pitc
O
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 1,500.00 UtilitiesSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name BRENNER Name: EDWARD FLACK
Address:18506 TRANQUILITY BASE LANE Company: KILOWATT ELECTRIC COMPANY
City: PORT ST LUCIE State:FL Address: 1700 NW 22ND AVE
Zip Code: 34987 Fax: City: POMPANO BEACH State:FL
Phone No.831-588-9396 Zip Code: 33069 Fax: 954-975-9946
E-Mail: Phone No. 954-975-8200
Fill in fee simple Title Holder on next page(if different E-Mail: EDDIE_FLACK@KILOWATT-ELECTRIC.COM
from the Owner listed above) State or County License: EC13001961
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:-N Name: N
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITL OLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: �f} Name: n/I
Address:1700 NW 22ND AVE 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 thepermit 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 firg i spection. If you intend to obtain financing, consult with lender or an attorney before
commencV,dAfftor recording our Notice of Commencement.
G � i0•;1 :;0�
Signature of 0e-r/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
m
STATE OF FLORIDA STATE OF FLORIDAX0
-20 0
COUNTY OF Sc3►►ih�• �c12. COUNTY OF 2 ��
o �N
z 0c
Pa
The forgoing instrument wa acknowledged before me The for oing instru ent was acknowledged be f Tr
this day of C� C✓ 20& by this f day of 201�Sby
IS2 Flamm £�••o.. ��
�N
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identifi
Type of Identification Type of Ide tio,n,, /
Produced I)A vial, t ;U4vz L 3 6�t(7 -�(,�-&>-Ds 3r Produced W/ RAN) 4,G7 -CX -
(Signature of Nar Vic-State o (Signature of Nota P blic-State of Florida)
My COMMISSION#W 197243
Commission No. _- EXPIRES J 2022 Commission No. (Seal)
•.rF°FFA°?r Bwded-11mNotuyNbkU,&wtite.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17