HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/11/2018 SCANNED' Permit Number: O �
r . - RECEIVED
L-W-011111 Ian
— _ - Building Permit Application JUN 111018PermittinH Department
Planning and Development Services St. Lucie County
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 f•J:5 AU— 6q &.05:7 5.
PROPOSED`IIMPIROVfMENT LGCATION`.�` '"
Address: 2504 Lazy Hammock Lane, Ft Pierce, FL
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: 7 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Electrical Work ► T�.S�-�...iy oW�Ufe.�.S 8/,IC-TS
CONSTRUCTION INFORMATION: t.
Additional work to be nertormed under this permit-check all apply:
E1HVAC 13 Gas Tank Gas Piping _Shutters ❑Windows/Doors
ZElectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 2 4150 Vim' Utilities-0 Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: D c LAZt Z,4A/1Z Company: RO(vlE&S 17E5I4101 We-
city: 1 Stater/ Address: 'V-03 SW 41PO 1'lr"0W
Zip Code: y Faux:: City: -•" G�TSI State:F=L
Phone No. -7a- 7 7 72 Zip Code:34 L LlO Fax:77Z-203�Zel
E-Mail: IN4 Ov Phone No. 772-2Z8 3 e0q 1;Fill in fee simple Title Holder on next age(if different E-Mail: L Rv&r-4 ( T-I�tTL�F'!/✓S.Gy
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
� L
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address:2504 Lary Hammock Lane,Ft Pierce,FL 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 representation that is granting a permitwill 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 andireview 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
commencing work or recording our Notice of Commencement.
G
Signat re C(*bwnet7LVbssedContractor as Agent for Owner Signatu f Conl(actor/LiLInse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ COUNTY OF .Lwc�s.�
The forgoing instr ent was acknowledged before me The forgoing ins ument was acknowledged efore me
this da of 2d% by this W_day of Lk,,-,, 10 by
— J\""� +_��Q/� aA411
Name of pe son making statem t V Name of p rson makings ement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
dSna re of Notary Public-St he of Florida) (Sign at of Notary Public-State Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW_ REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17