HomeMy WebLinkAboutELECTRIC PERMITAll APPUCABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date; v Permit Number;
Planning and Development Services
Building and Code Regulation Division
23DD Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Building Permit Application
Commercial Residential boa
I PROPOSED IMPROVEMENT LOCATION: _ I
Address:
G I7/-ram
Property Tax ID ff: 4Y-c o -�- - So I — 1 �2- U ( - 0 C) v - 7 _ Lot No.
Site Plan Name:
Project Name:
Block No.
DETAILED DESCRIPTION OF WORK: III
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
G�
Cost of Construction: $ / koo
_ Gas Piping
_ Sprinklers
_ Shutters
—Generator
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Windows/DoorS
_ Roof _ Pitch
Building Height:
OWNER/LESSEE: I CONTRACTOR: I
Name — -C� (-_
Address: / 0 / �l /INc HI( r, 13 / o
City: s C h4 C- rS r 41 r, State: L
Zip Code: 3 rf'9s-_7 Fax:
Phone No6? -
E-Mail:
Fill In fee simple Title Holder on next page 1, if different
from the Owner listed above)
Name;John Law
Company: LaWs Electrical Service Inc.
Address:5158 NW Primm St
City: Pt St Lucie State: Fl
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-M a i l) oh nlaw 51580aoLcom
State or County License EC 13006370 29432
H 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 LIEN LAW INFORMATION:
MORTGAGE COMPANY: _ Not Applicable
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone;
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applica
Address:
Zip; Phone
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao me worK dno nUld11d111J11 I.IUIUo.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie CountNy 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 anal 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
__,. _ __J i._�....... 1. L.H..e ..F r•.,r.,..,nn�umonY
commencm VIK VI 1ULUIU11 IM Vuu-IYVULG v,
ell,
Signet of Owner/ Lessee/Contractor as Agent for Owner
Signature of ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
Oday of TV 20 ,240by
this 1Qday of Ten t . 20�by
this
Name of person rlr eking statement
Personally Known _ OR Produced Identification
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
of Notary Public State of Florida )
(Signature of Notary Public- State o
N r
RACHEL
DAVIS
t
Commission No. \ \ f a 1 My cOMMISB10
or` J
�R@9bo
try 5, 2019
No
RACHEL
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EXPIRES anu
MY COMMISSION #FFt
796-0157 FloritlallolaryS
NiCY.com
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION 9dE�.c
REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17