HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO y �MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �fj
Date: / —/J —dV ' Permit Number: A15 —0° `
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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 X Residential
PERMIT APPLICATION FOR: Electrical
,PROPOSED�IMPROVEMENT-'LOCATION
Address: 769 Rio Vista Dr#CAN
Legal Description: ROW L
Property Tax ID#: 2426-501-0005-9999 Lot No.
Site Plan Name: Block No.
Project Name: Comcast Power Supply Node FP 025
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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Install new Comcast power supply cabinet at first FPL pole west of S Indian River Dr, 7 ft south of
Rio Vista Dr road edge
CONSTRUCTCO)N [NFORMATION. . .'
Additional work to be nertormed under tis permit—c ec all appy:
HVAC Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
Electric 0 Plumbing Sprinklers FIGenerator E]Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 722 Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name Comcast Name: Gary J Gifford
Address:10435 Ironwood Rd Company: Gary J Gifford, Inc.
City: Palm Beach Gardens State:FL Address: 350 SW Linden St
Zip Code: 33410_ Fax: City: Stuart State:FL
Phone No. Zip Code: 34997 Fax: 772-219-0146
E-Mail: Phone No. 772-286-0954
Fill in fee simple Title Holder on next page(if different E-Mail: 9iffelec@comcast.net
from the Owner listed above State or County License: EC13001574
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: X 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 thepermit 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
commencin work or recording yo4r Notice of Commencement.
Signature of Owner/Agent/Lessee Sign ure of Con ctor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oin inst ment as acknowled ed',Wore me The fo ing instru nt w acknowledged before me
this�day of 20� this M day of 20 by
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(Name f erson owl d ing (Name of p n ac ledgin
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(Signature of Notary Public-State of Horida) Signature of Notary Public-State of Flori a)
Personally Known OR Produ Id ntification s_IV/ Personally Known ORPro)daqpfdlde tification
Type of Identification Pr d- _ I e of Identification Ppi .
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Public State of Flori a
Commission No. _ 1
? « mmission No. N�iSeal AWN MILONE
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Commission# EE 877571 f Florida
AQ"Pc My Comm.Expires Mar.92
Bone roug, %;OFF�OP` mission#EE 87787
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Revised 07/155/20141-WO ".." o
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