HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: I fss ow —oon._s— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK:`
0 �
CONSTRUCTION INFORMATION:
Additional work toe e orme under t —checkispermit a appy:
❑HVAC 11 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
ZElectric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
C�
Cost of Construction:$ � C� Utilities: _Sewer❑Septic Building Height:
OWN ER/LESSEE,: CONTRACTOR:
Name \ ; q Re ' " Name: John M.Applebee
Address: - �C)w Company: JAK, Inc. d/b/a Applebee Electric
City: "VA , r \e,,(?_C.e State: A Address: P. O. Box 15
Zip Code:---A 4 c1 Ll"I Faux:: City: Ft. Pierce State:FL
Phone No. an 0- 1r)L) Zip Code: 34954-0015 Fax: (772)466-3765
E-Mail: Phone No. (772)466-7930
Fill in fee simple Title Holder on next page(if different E-Mail: applebeeelectric@bellsouth.net
from the Owner listed above) State or County License: EC#0002956
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: 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:
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
cogmTeTWg work or recording our Notice of Commence
s
gnature of wner/Lessee/Ag t Si ature of ontractor/Licens er
S TE 0 LORIDA S T F FLORID
COU OF i� COUNTY OF
�y '
The for ing ine t was acknowledged bed a me The forgoing in ument was acknowledged before me
this day of 20/ by this.L day of by
T(Neofperson ackno led ing) (Nam operson acknowledg g)1 J
(Signature of Notary Public-State of Florid (Signa ure of Notary Public-State Florida)
Personally Known OR Produced Identification Personally Known
Type of Identification ads — — — &-a—, Type of Identification Prod ced '4 ""O, DAWN NIiLIINE- -
,•,,Qy P� , DAWN CDN z. ; . Notary u is- a Ida
Commission No. ;a°`� ;`� Nots"LPAIllic-state of Florida Commission No. �; M 9� Expired Mar 22,201
•_My Comm.Expires Mar 22,2017 °.• &OXIssion'0 EE'877571
Commission d EE'877571
%° d`� Boddad Through National Notary,Ass .
°;,;�%V' Bonded Through Nationa oar
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS