HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I l) \\ SCANNED Permit Num
BY
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St. Lucie County
Building Permit Applicatiol
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 X
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
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t. Lucie County, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: _
Address: ' ' ' ""'
Legal Description:
Property Tax ID #: 3 4 3 1 I yZ0 D r7 / b O O s' Lot No.
Site Plan Name: Block No.
Project Name: customer kiosks
Setbacks Front Back: Right Side: Left Side:
I41DETAILED DESCRIPTION"OF V1/ORK.'
add two 20a circuits from panel A in existing conduit to kiosk location
add cat6 wire from each kiosk to data room
ing L1Shutters
ars ❑ Generator
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 1500.00 Utilities. ewer Septic Building Height:
n� Windows/Doors
I J Roof = Roof pitch
O,UVNER/LESSEE '
:CONTRACTOR:,
Name Florida State I Urnpl a Authority
Name: KoDert ivi Manning
Address: 1211 Governors 6quare Blvd
Company: Manning Electric o Vero Beach,Inc.
City: Tallahassee State:
Address: C Ste
_
Zip Code: 32301 Fax:
City: Vero Beach State:_
Phone No.
Zip Code: 32962 Fax:
E-Mail:
Phone No. 0
Fill in fee simple Title Holder on next page ( if different
E-Mail: mane eC2 (a—) bellsoutn.ne
State or County License:
from the Owner listed above)
iY vaiue ui cumirucnon is acouu or more, a newnueu ivonce or commencement is required.
fSUP,PLEMENTAL 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 TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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 ncing, consult with lender or an attorney befor
commencing work or recording vour Notic �� "' ncement. ,:r..b:: „•:
Signature of caner/ Lessee/Co tractor as Agent .Fr
Signature of Contractor/Li ense Holder
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STATE OF FLORIDA 2 m
STATE OF FLORIDA
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COUNTY OF y�
COUNTY OF
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The for ng ins um nt was acknowledgIrU7efore �,
this day 20/�! by
The f ing ins ent was acknowledge before
this day o 20 ty
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Ro � r ra dJ � 1 �N
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Name of person making statement
Name of person making statement
Personal) n OR Produced Identih ion
Type of Identifica n IInn
Produced C �t�l
Personally Known OR Produced Identification
Type of Ident- icati nil _
Produced G r'
(Signature of NcUry Public -State of Florida r
(Signature to of �Iorlcla
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17