HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 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: Q'9, �
Legal Description:
Property Tax ID#: C7 1N 1001— co iJ" oci n '-is— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe nerformed under tispermit—check all appy:
HVAC 0 Gas Tank E:]Gas Piping _Shutters a Windows/Doors
ZElectric 0 Plumbing Sprinklers FIGenerator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Oa Utilities:El_Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Namel Q�;k 'Ed i T"li 4 1A Aker A i f- LL_.0 r Name: John M.Applebee
Address:CI L49 W dDyGA N L-P_ (�l nSso rn' (EL Company: JAK, Inc.d/b/a Applebee Electric
City: !D`L L M4-D C) State: TO I Address: P. O. Box 15
Zip Code: ?)a'R 1 C7 Fax: City: Ft. Pierce State:FL
Phone No. 7-14—LI to�^��U 0 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.
L _ 1
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
co nc work or recording our Notice of CommenceMvM
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gnature of caner/Lessee/Age SU�TEFLORI�_
ontractor/License 'of r
TE LORI SCCJNTY OP. C
The for oing inst ent was acknowledge
d,b6ore me The foing i ument was acknowledge fore me
this day of 20 ( by this day of 20 by
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(Na of person acknowl dng..)— (Na of person acknowle gin )
o Notary Publi to a of Florida a of Notary Public-State of Florida)
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Personally Known ,•�•QYPq �Produce�Ppt {rt �P1 Personally Known OR Produced Identification
Type of Identificati r-0
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Type _ 017 Type of Identification Produced
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Commission EE 877571
Commission No. '-;; o?�' (Seal)
onded Thr� �tional Notary Assn. Commission No.
�P DAWN MILONE
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Revised 07/15/2014 •: �; trN°ty.�p°bI1C-State of Florida
Y CojBm.Expires Mar 22 gnil
14 stun if EE 877571
Bo r h Na'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION"le
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS