HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPUCABI/� IN�IFO, MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application
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PlanningandDevelopmentServices JAIL 2 6 2017
80d1ng and Code Regulation Division
2360'1691Wl Avenue, fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMITAPPLICATIONFOR Electrical
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K` -•`,..r,..� _'75
Address: 11z50 Bluefield Rd port stLude FL 34987
Legal Description: Main Line Valve
Property Tax ID q: 411043300200006 Lot No.
Site Plan Name: Florida Southeast Pipeline Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
a
ona wor o e errorme un ert115perms -c ec an ppy;'.
HVAC ❑Gas
Gas Tank Piping _Shutters Windows/Doors
Electric . O Plumbing ❑Sprinklers .. I,( Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of Flrst Floor.
Cost of Construction:$- �i `r.�il D Dv Utilities:�SewerliSeptic
Building Height:
Name Florida SE Connection UC/ Rich Scalese '. 4
' Name: Rod Sheldon '
Address:700 Universe Blvd Company: The State Group Ind USA Limited
City; Juno Beach State: FL Address; 3009 McCormick Dr
.Zip Code: 33408 'Fax: Ct Janesville
?Y-' State: Wi
BhoneNo.: 5b1- 236-9/9 S ZipCode:.63646'. Fax:
E-Mail: t ii- d1-d.SGa1eSP (dhse Goltn Phone No. 808.7SB•9486
Fill to fee simple Title Holder on next page (if different E-Mail: csheldon@stategroup.com
fromtheOwnerflsted above) Stateortountyucense: F-C130=64
' If value of constructton Is $2S1)0 or more, a RECORDED FoUceof Coinmeneement is required. v
-F111Ce der)Y)--1)T Q
NE ENGINEER: x Not Applicable
MORTGAGE COMPANY x_ Not Applicable
N
Nam
Name.
Name:
Address:
Address:
City: State
Zip: Phone:
city:State
Zip: Phone
FEE SIMPLE TRLE HOLDER: Not Applicable
BONDING COMPANY: ' !--Not Applicable
Name'
Name:_
Address:
Address:
City:
City:
Zlp: Phone:
ZIP:. Phone:
I certify that no work or Installation has commenced prior to the issuance of a permit. .
St. McCountvmakesnorepre entatlonthatIsgrantinsapermitwillauthorizethe ermitholdertobuild the subdectsVucture
whichislnconfllctwitnanyapplicableHomeOvmer3AssociationruleS,bylaws4rangpcovenantsthatmayrestrltt rprohhibitsuch
structure. Please consult with your Home Owners Association and review
your geed 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)obsite
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.
�ctor/License
Signature Owner/Le Contractor asAgentforOwner
5igma� Holder s
STATE OF FLORID_ I Z _ p
STATE OF f+lMlfCA � �ScrS
COUNTYOF GCS4( it
COUNTY OF �f�
The fo oing instru nt was acknowledged before me
this' da{yof Qr l� j2by
The fo oing Inst ment was ac nowledged before me
av
thffssy��dayofJ4�20 (( by
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// `Clod )g%(�
(Name of person acknowledging) -
(Name of person acknowledging)
(5 r 4 s)<Sw_&'S�
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(SlgnatureOfNota Public -State offer)
Perlary Pu�blic -
da odifiRP.Efi®Personally
W-T
Known OR Produced Identification
Type of Isona
Type of Identificatl�uced
Commissio
-
Commfssion No. % 7 Z (Seal)
Reyised 07/15/2014 JEANETTE J. ROSENBAUM
Notary PuDfie
Stat
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