HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IlyFo MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I l a Permit Number:
Building Permit Application
Planning one yeveiopment]enncea
8ui;mi i and Code Reguiation Division
2300 Vrginio Avenue,Fort Pierce FL 34992
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential xxxxxxxx
PERMIT TYPE:
,
PROPOSED IMPROVEMENT LOCATION
Address: /070 /. SOufA 0Cr4% 12Y& �SU
Property Tax ID#: 4.1 - ,S ( U - G G S !— GO G - q Lot No.
Site Plan Name: chnv non
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace Existing Meter pedestal
CONSTRUCTION INFORMATION:
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:$ I U U Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE; CONTRACTOR:
Name .4/hyr, to 4- M4 ir'� �ri�s Name.�villi
Address: /o )a i 9. o < 4b gft Yl j?rw Company-Laws Electrical Service Inc.
City: irc <is L State:zY Address:51 58 NW Primm St
Zip Code: Fax: City: Pt St Lucie State:Fl
7 7 A - (07&' 9A'-(S 717rnde• 34983 Fax:
E-Mail: I Phone No 772 370 4357
Fill in fee simple Title Holder on next page(If different E-Maillohniaw5l68@aol.com
from the Owner listed above) State or County License EC 13006370 29432
of rY mmPn,*Mont Is reaulred.
II tlO,NW Va . V Y+air a.If value of HVAC is$7,5W or more,a RECORDED Notice of Commencement is required. l
SUPPLEMENTAL CONSTRUCRON 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 represerptation that is granting a permit vrll authorize the permit holder to build the subject structure
which is In conflict with any applica le Home Owners Association ru es,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 1 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 tender or an attorney before
commencingwork or recording our Notice of Commencement.
Signat of Owner/Lessee/Contractor as Agent for Owner Signature 4rontractor/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
this_ I day of Al&v 20$f by this J-�_day of 20,�jk by
Name of person m king 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 of Notary Public State o f Notary Public State of Florida)
RACHEL N DAVIS
Commission No.Lv MY COMM15510 iCSI No
? f ..."
EXPIRES Janury 5,2OS8 s { �. � RACHEL M DA 1
� /�;
i • My COMMISSION#FF7 17 t
(aW)a9a-0t53 FforidaNpta rv��am c"S-.. - :
I , S January 5,1� C9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION >
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REV[
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17