HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_1��l S Permit Number:
RECEIVE'D JUL 21 ZOIC
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 INPROVEMENT LOCATION:
Address:a418 TAMARIND DR, FORT PIERCE, FL
Legal Description: FORT PIERCE SHORES-UNIT 1-BLK 1-LOT 4 (OR 3320-1449)
Property Tax ID#: 1436-601-0005-000-2 Lot No. 4
Site Plan Name: Block No. 1
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
REPLACE + DAMAGED WEATHER HEAD hQb
CONSTRUCTION INFORMATION:
Additional work toe performed under this permit—check all appy:
❑HVAC 0 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑✓_Electric ❑ Plumbing OSprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction:— 1 S Ft. of First Floor:
Dost-of-Constr`uction:$ romp Utilities:
0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name JOCELYN BEZNER Name: JOHN M.APPLEBEE
Address:267 MARINA DR Company: JAK, INC. DBA APPLEBEE ELECTRIC
City: FT. PIERCE State:FIL Address: P. O. BOX 15
Zip Code: 34949 Fax: City: FT. PIERCE State: FL
Phone No.(575)430-4104 Zip Code: 34954-0015 Fax: (772)466-3765
E-Mail: Phone No. (772)466-3970
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: 19055
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:
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 obtain financing, consult with lender or an attorney before
coD=gncing work or recording our Notice of Commen "en .
Ilgnature Owner/Agent/L 'se ;,5ii(gnature of ontractor/License Id r
TAT F FLORIDA ST F FLORIDA
C TY OF Sai'. 1-��-�"k COUNTY OF S
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this'Q,1 day of ZU\y 201%.51 by this LCDL day of 20EMby
d �a�e �� �
(Name of person acknowledging) (Name of person ack o ledging)
(Signature of Notary Publ -State of Florida) (Signature of Notary blic-State of Florida )
S S
Personally Known'
00 41 48t 4da Personally Known 0 entift®RI GIVEN t Flonda
�6 �, ar Pub1i��16.20"
Type of Identificatio iced Z e� Type of Identification Produce .,K c-
omm•ExP #EE g5 pssn� =2'
Commission No.t. _ _�y 0 m ou9^ a\No\ary Commission No: ��5$ _o �`: My4nisSion#EE 8587 pss
Dom ' iron {hrou9h National NoluY
9
' oec ondedZhr '-.��Eo�F�°.•' onde
�rE OF F�'•� Ij `
Revised 07/15/20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED