HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDI
Date: 12/17/18 Permit Number: l•/11
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F L O R I D A
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Building Permit Application 0cFIL ;i
Planning and Development Services I> ®FC 17
Building and Code Regulation Division er„ittjn tO1B
2300 Virginia Avenue,Fort Pierce FL 34982 3�,<p�eoep�
Phone: (772)462-1553 Fax. (772)462-1578 Commercial Reside %4
PERMIT APPLICATION FOR: Electrical
PROPOSED.IMPROVEMENT LOCATION ;--
Address:
=Address: 5004 Hickory Drive
Legal Description: Indian River Estates-Unit 07, Block 46, Lot 10 1
Property Tax ID#: 3402-608-0205-000-6 Lot No.10 11
Site Plan Name: Block No. 46
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace meter & riser per FPL
CONSTRUCTION INFORMATION
Additional work to be erformed under this permit—check all eha apply:
HVAC Gas Tank Gas Piping _J Shutters I l Windows/Doors
ElElectric 0 Plumbing Sprinklers 0 Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S . of First Floor:
Cost of Construction:$ _ //00. 0 D Utilities:Sewer ElSeptic Building Height:
OWNER/LESSEE CONTRACTOR:,
Name L.4 itrer ce, 6_ Kai,IQ r, Name: r .-”
��'�J7�' Yrn4)ohs Sr
Address: L$1P 5 1-km kn1 q hn Lane Company: :-.3.-Des €#vi c o(-S)- ktcA•e. ��, inc.
City: DPMI 1ze�t.., (L&di ✓ State: fL- Address: /43,01,0/00. 4 v�'D u-e
Zip Code:33y y 10 Fax: City: FD')Y 19.•.0 PAZ- State:PL-
Phone No. 510 1 3°7-0149D- Zip Code: 3N 4 S'2 Fax:
E-mail: 14 rri )(Ay 3 J rrAA. ). C.-01-pm Phone No. 1 7 L 1,5.23 103
Fill in fee simple Title Holder on next page(if different E-Mail: j DL'S' e.I eco' JLi Gi e ® Flo 1- corm
from the Owner listed above) State or County License: CC i3 0 072.0',
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION , •
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
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Name: Name:
Address: Address:
City:__, _ State: City: State: '
Zip: Phone Zip: Phone: _ .
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. i,
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 anyapplicable Home Owners Association rules,bylaws or and covenants that mayrestrict or prohibit such
structure.Please consult ith your Home Owners Association and reviw your deed for any restrictions hich may aply. 11
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work 'I
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments. i
The following building permit applications are exempt from undergoing a full concurrency review:room additions, 1
' accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use ,j
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
comm ' g work or recording your Notice of Commencement:--
GFS 2, r � v` 4
Signat re of •wner/ essee/Contractor as Agent for Owner Signature : Co ractor/Lice se Holder
ST TE OF FLORIDA ST. E OF FLORIDA
UNTYOF •UNTYOF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I j day of b-P( ,20 18-by this( ' I day of bt,Ca ,20 1' by
3+ -_ f M r I ill t, 50sp jh EMM 9 V"lY'1
Name o person making statement ✓ Name o person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced r L /D Produced p L--- _ I'
,,
VC(J119. -----------
(Sign re of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
"yP'� Com Fission No.(- --;1760-? (Seal)
Commission No. 6� � ;a•�Seal)ELLEN VAUGHN
:° i io'_State of Florida-Notary Public +
*= Commission #GG 270079
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"bFcuo-,s• My Commission Ex►ire • o"nuq, ... >, . <�.... ...,...
(6,---. 9 2 :� �°/iii -State of Florida-Notary ^u6 is
REVIEWS FRONT ZONING S P '` •' I• ' S VEGETATION ► •1,i;,+, EC°n9 At4I ROCID710-e
COUNTER REVIEW REVIEW REVIEW REVIEW f ' iitV MyOo a 2o2pi e:
DATE T —_
RECEIVED
DATE
COMPLETED ,
Rev.8/2/17
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