HomeMy WebLinkAboutBUILDING PERMIT APPLICATION/V$02-0
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A05
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• St. Lucie County
liliBuilding
Permit Application MAY V ® " !3
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial xx Residential
PERMIT APPLICATION FOR: Electrical
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Address: 1 A �' i9r_e4 a ll r
Legal Description:
Property Tax ID #: 4512-331-0002-020-1 Lot No.
Site Plan Name: Courtyard By Marriott Jensen Beach Block No.
Project Name: Fire P_umpsepair- C6'y1V0 (l,r a4PLk
Setbacks Front Back: Right Side: Left Side:
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Provide electric for fire pump/repair
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AdditionalworK to ne DerTormea uncier this permit— cneCK all apply:
11HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq� FFtt.I of First Floor:
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Cost of Construction: $ L 000.' Utilities: Sewer OSeptic Building Height:
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Name.e-)Cj i i
Name: Joh L.vwel,
Company: Knight Electric Company, Inc.
Address: IMI 6- AIar*C—Ave 56G at lol _
Address:, 51'13 (p�A(_ 31Y"l-1 �;�
City:.W(N 2)e'^ 1 State:�L�
City: ��zn Q&Q r f-- State: FL
Zip Cooe: 3- W Max:
Phone No.
Zip Code: 33404 Fax: 561-689-2876
E-Mail:
Phone No. 5461-689-3500
Fill in fee simple Title Holder on next page (if different
E-Mail: jford@knightcorporations.com
State or County License: EC13002343
from the Owner listed above)
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is re fired.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _
Not ApplicableT
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ 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 permit will authorize the permit holder to build the subject structure
which is in con ict 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 ofthis.requested per 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,rsigns, screen rooms and accessoryuses to another non-residential use
WARNING Trins4ection.
ER: Your failure to Record a Notice of Commenceme t may esult in your paying twice for
improver tour property. A Notice of Commencement must b recor ed and posted on the jobsite
before the fi If you intend to obtain financing, consult ith ler� er or an attorney before
commencinr recording our Notice of Commencement.
Signature of ner/ Lessee/Contractor as Agent for Owner
Signature of Co tractor/License Holder
STATE OFF ORID
STATE OF F RIDA
COUNTY O /`!��/hn- �lO�c�.y��
COUNTY O
The forgoing ns ru ent was acknowledged before me
The forgoing in to ment was acknowledged §efore me
thisZ'2day 20a by
this -adayof 20 by
Name of person making statement
Im
ame of person aking st ement
Personally Known f/ OR Produced Identi
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Perso y Known OR Produced Iden fica.
Type of Identification
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Type of Identification
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Produced
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(Signs of Notary Public- State of Florida
k4opafure of Notary Public -State of Florida)
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Commission No. (Seal
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Commission No. (Sea) `-' tS
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REVIEW'
REVIEW
REVIEW
REVIEW f
DATE
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RECEIVED
DATE
COMPLETED
Rev.8/2/17