HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: � 2)fl—I Permit Number: 52—f""SDq
- - -- SCANNED
Building Permit Application BY
Planning and Development Services St. LUCie Count
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553_ Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Electrical ❑ II
PROPOSED IMPROVEMENT LOCATION:
Address: 5720 Spanish River Road, Fort Pierce, FL
Legal Description: Portofino Shores (PB-43-6) Tract R-1 (2.022 AC) (OR 1658-2244• 2533-
2994)
Property Tax ID #: 1312-501-0020 000-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Re —configure hi —leg of existing meter due to FPL change (adjacent to clubhouse
area)
CONSTRUCTION INFORMATION: III
LJHVAC LJ Gas Tank
Electric ❑ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 2,400.00
❑Gas Piping ❑ Shutters ❑ Windows/Doors
❑Sprinklers ❑ Generator ❑ Roof
Sq. Ft. of First Floor: _
Utilities: Sewer ❑ Septic
Building Height:
OWNE LESSEE:
CONTRACTOR:.
Name
Michael Hale Ault
Address:
Company: Ault Bros, Inc. Electiical Cont
City: Statp-41
Zip Code: Fax:
Phone No.
Address: PO Box 1528
City:Port Salerno State: FL
Zip Code: 34992 Fax:772-283-0321
Phone No. 772-283-5520
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: aultbros@yahoo. corn
State or County License: EC0001693
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 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 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 your Notice of Commencement. I/
_ Signature of Owner/ Lessee/Agent
Signature of-Contractor/License Holder
STATE OFF R
ORIgA A LQ
COUNTY OF,,
_ �
NTY ��C
COUNTY OFT
The forgoing instrument was acknowledged before me
7^d\ay+ 20 �y
The forgoing instrument was acknowledged before me
this--off;fll day � 20/����sy
th�i of,,
of .
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(Name of person acknowledging )
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(Name of p rson acknowledging )
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(S gni Lure of Notary Public -State ,Floridan
(Signature otary Public- State of Flo 'da )
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Personally Known OR Pro a dentification
Personally Known - O - I ntification
Type of IdentificationIdentification
l'�'pV8 DAWN MILONE:'
Produc r -
.nit DAWN MII n
Commission No. F E N y011c • State o1 Florida
• ' g My Comm.
L" ayPO
ommission No. - i tabNF
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. expires Mar 22. 201
��, COmmleelan / EE 877571
s%sttS C011lmlp /Ra'INar22.2
Banded Through National Notary Assn '
Revised 07/15/201
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