HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
, � __ 4 )
Building Permit Application l e-C,
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
P,ROROSED.IM'PROVEMENTkLOCATION
Address: /�)(00 n 1 LSC
Legal Description: 0( Gti.50`
Property Tax ID#: D co Qd ® / Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: g
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DETAILEQ`DESCRIPTION OF WORK
St Q
CO.NSTRUCTIONIfVFORMATIONn
itiona work to beperformedd under this permit—checkk atha
appy:
1]HVAC EiGasTank ❑Gas Piping _Shutters Q Windows/Doors
FI
Electric El Plumbing Sprinklers Generator
ERoof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ I�d UtilitiesInSewer 0Septic Building Height:
OWNER/LESSE.E y yCONTRACTOR
Name rY)Q 0, Name: iV
Address: S L D-- i company: , S L-<7"% (20 A- 7-
City:
City: Stater Address: :3 / 7 Sh
WO Y
Zip Code: 3 I(ri 7 Fax: City: Stater.
Phone Nom9^ Zip Code: Fax:
E-Mail: l31J� . (�r-, �[�a .-zee Phone No. 7 � Z ''
Fill in fee simple Title Holder on next page(if different E-Mail: �C'
from the Owner listed above) State or! my License: d6 cam
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL"CONSTRUCTION LIEN LAIN IN_PRMATl0
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, consultwi kl lender or an attorney before
commencingwork or recordingour Notice of Commence J
0
s
_Signature of Owner/Lessee/Agent Sign ur of ontractor/License Holder
STATE OF FLORIDA SJF FLORIDA r p
COUNTY OF ��� C Y OFA, I _Z
The forgoing instrument was acknowledged I}efore me The forgoing instrument as acknowledged before me
this ISI—day of l 20l-S--by this/ST ay of 20 L_,C by
(Name of person acknowledging) (Name of person ackn wledging)
(Signature of Notary Public-State of orida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known_t OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. 0'9 (Seal)
Notary Public-State of Florida
Revised 07/15/2014 My Comm.Expires Oct.8,2017 Notary Public-State of Florida
Commission#FF027328 =�+ '�= My ommission# Oct.8,2017
Bonded Throug I National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS