HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: dek0241 Permit Number:
Q:aj
Building Permit Application
Planning and Development Services
Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982Phone: (772)462-1553 Fax:(772)462-1578 Commercial ResentaX
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: 130111-0001-000/eLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace meter center with a combo pack as
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit—check a appy:
HVAC0 Gas Tank Gas Piping _Shutters Q Windows/Doors
FV]Electric 0 Plumbing Sprinklers F Generator a Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ _ _DC7, o Utilities. _Sewer Septic Building Height:
OWNERAESSEE: 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
Phone No. 772-878-5513 Zip Code: 34952 Fax: 772-878-3347
E-Mail: Phone No. 772-971-4512
Fill in fee simple Title Holder on next page(if different E-Mai): lawselectricinc@aol.com
from the Owner listed above) State or County License: ER0000122
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: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Aot 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
nature of Owner/Lessee/Contractor as Agent for Owner Sipifture of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,/ COUNTY OF
The forgoing instrument as acknowledged before me The forgoing instrument was acknowledged before me
this�_day of 20jl by this g_day of .20/!� by
441 t�Sg i� Low ¢ll,1e=-Q eco u�-A- d
Name of person making statement. Name of person making statement.
Personally Known !/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature o �5 Florida) (Si nature StBttWeFlorida)
NOTARY PUBLIC Q NOTARY PUBLIC
CommisG( c F FLORIDA (Seal) Commiss J + ORIDA (Seal)
Comm#GG262780-11yComm#GG262780
ei A Expires 51=2 Expires 9/26/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.