HomeMy WebLinkAboutBuilding Permit Application ---
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I ALL APPLICABLE INFO MOST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: if . .. .0 4 Permit Number: 110 --‘ 03 75
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Building Permit Application
Planning and Development Services
,1 Building and Code Regulation Division 1
2300 Virginia Avenue,Fort Pierce FL 34982 ?
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
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PERMIT APPLICATION FOR: Electrical E
PROPOSED INPROVEMENT LOCATION:
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Address: i/S:'5:=4-1.L,6..: ./ I "it" -,-.. ,,
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Legal Description:
Property Tax ID#: 3414-501-1701-00019 Lot No.
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I Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
Replace meter center with a combo pack eff_tee_r_d)
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1 CONSTRUCTION INFORMATION:
As sitiona wor to se e °mei. unser t is permit—c ecc a • appy:
Gas Tank
FIHVAC EiGas Piping Shutters Li Windows/Doors
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Electric LJ Plumbing LiSprinklersI— Roof
0 Generator
Total Sq..Ft of Construction: sil,Eti of First Floor:
Cost of Construction:$ i c5Da. &d> Utilities:I 'Sewer E Septic Building Height::
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OWNER/LESSEE: , CONTRACTOR:
Name Wynne Building Corp. Name: James W Law
Address: 8000 S US#1 Suite 402 Company: Law's Electric, Inc.
City: Port St.Lucie_ State: FL Address: 218 Beach Avenue
Zip Code: 34952 Fax: City: Port St.Lucie State: FL I
Phone No. 772-878-5513 Zip Code: 34952 Fax: 772-878-3347
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1 E-Mail: Phone No. 772-9714512 I
Fill in fee simple Holdall,on next page(if different E-Mail: lawselectricinc@aol.com
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Ifrom the Owner listed aioove) State or County License: ER0000122
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ji 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
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.
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 your Notice of Commencement.
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Si:I:ture of Owner/Agent/Lessee Si: ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
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COUNTY OF �,// c
/��� COUNTY OF
The for ing instrnt was acknowledged before me The for ing instrump t was acknowledge efore me
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this f day of `Ift)V/a-� $ ,201 r[ by this I'day of _.J (J/9'q ,201Y-by
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(Name of perso cknowledging) (Name of person acknowledging
.,i-atil i ,-4 ilerla/C-
(5ignatu a of Notary PubliS,jSi,= f Florida) (Si nature of No lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
,~pity._ BeveryJ.Proske PS
Beverly J.Pros1ce
Commission No. .1 .. • ARY P1ig
9� Commission No. NOTARY PU>�
f� STATE OF FLORIDA ii r'• a , STATE OF FLORIDA
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Revised 07/15/2u.e419-11:1 •Expires 9/26/2022 it.:...
�e� Expires 812612022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER , REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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