HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: jxA .zplq Permit Number: \dN
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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
-PROPOSED INPROVEMENT LOCATION:
Address: /.4-:5726 !z
Legal Description:
Property Tax ID U.- Lot No.
Site Plan Name: Block No.
Project Name;
Setbacks Front_ Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONS TIRUCTION INFORMATION.
Additional worR—ttob-Le—ip3-e-ffOrme d under this Permit-check all t=apply:
11HVAC E—]Gas Tank []Gas Piping —Shutters Windows/Doors
Electric Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ C) Utilities:I. Sewer F SePtic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Wynne Building Corp. Name: James W Law
Address- 8000SUS#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. 772-878-5613 7jp 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-Mail: lawselectficinc@_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.
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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 TITLEHOLDER: 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 permitto 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 holderto 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 FINAKCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:'
ature of Owner/Lessee/Contractor a/s'Agent for Owner ' ature o Contractor/License Holder
STATE OF FLORIDA ,� STATE OF FLORIDA � '
COUNTY OF r��75./,C•C.C� COUNTY OF _yg=Z : ��--
The forgoing instrument was acknowledged before me The forgoing Instruments s acknowledged before me
this n2 day of 3 ' _ .20J�by this day of 26,3 by
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
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{Signature Of (Signatures g Florida)
a t^ STATEOF FLO u STATE OF FLORIDA
Commission$ 0 62LO I} Commissl m+�Gd3627B0 (Seal)
fi l �' (Expires 9126/2022 �Nca;19�' Exair��94612022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7719
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