HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: 9/10/15 Permit Number: I S64' 0143
HIM
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 x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOS:ED,IMPROVEMEN,T LOCATION:
Address: 103 Beach Ave Port st lucie fl 34953
Legal Description:
Property Tax ID#: 34195150040008 Lot No.13
Site Plan Name: Block No. 5
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace electrical service
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—c ec a app y:
HVAC 13 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
EJElectric 0 Plumbing Sprinklers E Generator g Roof
Total Sq. Ft of Construction: 1570 S . Ft. of First Floor:
.Cost of Construction:$ 1200
Utilities Septic Building Height:
OWNER/LESSEE: ',. CONTRACTOR:
Name Michael A Masto Name: Samuel James Eades
Address:942 Montgomery St Company: Advanced Lighting Designs
City: San Carlos State:CA Address: 949 sw jeremko ave
Zip Code: 94070 Fax: City: PSI State:FL
Phone No.6505760662 Zip Code: 34953 Fax:
E-Mail: Phone No. 772-370-2113
Fill in fee simple Title Holder on next page(if different E-Mail: eaelectric@yahoo.com
from the Owner listed above) State or County License: ec13005896
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU PPLEMENTAL'CONSTRU,CTION.LIE,N 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: _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 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
commencing wor r recording our.Notice of Commencement.
s
_Sig r er/Les a/Agent gn ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C -_�,.f; o COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged efore me
this day of 20 JSby this Al day of 20 by
FOL CL
(Name of person acknowledging) (Name of person acknowledging)
Ogn#at'Uref Notary Public-St4te o-fTiorida) \ gniture of Notary Public-Sta&of Florida)
Personally Known OR Produced Identification� Personally Known OR Produced Identification
Tff e of Identification Produced Type of Identification Produced
V- - ' G3ZO •-1Qa.�3. DSO•o
Commission No. (Seal) Commission No. (Seal
INGRAM golf", LASHAHNA INGRAM
LASHAHNA ate o1 Florida R ,
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State of PI Ja
, No CO m EXpiresDe177249 N,: ;� My Comm.Expires Dec 20, 18
Revised 07/15/201 . _ +'_
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DATE
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