HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. 'I
Date:_ / -aa- A O Permit Number:40D r) 04
-� 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 ✓
PERMIT TYPE:Electrical
PRO POSE D:IM PROVE MENT°LOCATION.£
Address: 3l OV, D vbnr\ T
Property Tax ID#: D Lot No. 3.
Site Plan Name: Block No. ( /
Project Name:
DETAILED DE SCRIPTION'.OF WORK:
r��l-,.-e 100 AV-%2 tylel n Dr-ea tc-Ev--
CONSTRUCTION`IN FORMATION:
Additional work to be performed under this permit—.check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
✓Electric Plumbing _Sprinklers Generator . Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ a Sr0 Utilities: _Sewer _Septic Building Height:'
OWNER/LESSEE: CONTRACTOR:
Name Br•o'ca Real.iy. Name: [70n1'
�- I- SL ,� b1vO Company:S&W Electric Inc
Address:_ 1 / S I��r L�,�
City: P19rT St-. Lvc;e_ State Address:5Q1, west Coker,Road -
Zip Code: �`1 �� Fax: . City: Ft Pierce ' ,. . , „r:. ?'; :State:FL
Phone No. '7 71 Sr77 233 k Zip Code: 34.945` ,Fax:.
E-Mail: Phone No772464-6466" `-
Fill in fee simple Title Holder on next page(if different E-Mail stuboutelectric@aol.com
from the Owner listed above) State or County License 3 O d 7 f
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION"15N.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;instaliation as indicated.
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 Lwill,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 concurrencyreview: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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of O er/Lessee/Contractor as Agent for Owner Signature of Co ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA.
COUNTY OF �- 'a.� , COUNTY OF
The forgoing inst vnent was acknowledged before me The forgoing instr' ent was acknowledged before me =
this,day of 2Q0 by this> day of L 21.V) by
Name of person making statement. Name of person making statement.
Personally Known OR Produced identification Personally'Know - - OR Produced Identification
-; Type of Identification :Type of Identification _.
Produced Produced
(Signature of Notary Public- ate of Florida) _ .:;; (Signa09re of�Vublic- of Florida)
Commission-No :; Y'y' LASHAH"AINGGI� MING G
"' )j 'u275oso r (Seal)
MISS I` :1 ;° rP4 0. LASHAHNAINGRAM-RAHMING
p,,EXPIRES:December 20,-2022 �: =r .
•.•OF F„••. .WIC (U
f by EXPIRES:December2 ,
' �d,4�111r�
REVIEWS 1NG ' SUPERVISO,R,, ISLi;i dAI ,TrI� 1C i
• TLE MANGROVE_
"COUNTER REVIEW ` _;;. REVIEW VV----- REVIEW,
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19