HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: 9/29/2015 Permit Number:
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�D SEP 2 9-2015
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 yes
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 409 Poplar Ave Port St Lucie, Florida
Legal Description:
Property Tax ID#: J "\ 0— 'S 9- 600'- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Correct 4 Point Inspection electrical panel double taps. Electrical meter needs to be removed to
perform work.
,_CONSTRUCTION INFORMATION:
itiona wor to e e orme under this permit—c ec a t t appy:
HVAC rl Gas Tank E]Gas Piping _Shutters Q Windows/Doors
RIElectric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 500.00 Utilities:nSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Mark Mendelson Name: Steve Blackford
Address: Company: Southeast Electrical Constructors, Inc.
City: Coutlandt Manor State:NY Address: 1402 SE Concha St
Zip Code: 10567 Fax: City: Port St Lucie State:FI
Phone No.917-468-7849 Zip Code: 34983 Fax: 772-879-1203
E-Mail:upperlimit54@hotmail.com Phone No. 772-260-6622
Fill in fee simple Title Holder on next page{if different E-Mail: steve@southeast-electrical.com
from the Owner listed above) State or County License: EC13005001
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
DESIGN ER/ENGI NEER:
NFORMATION: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 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
commencing work or recording a of Commencement.
S
S,rnature of Owner/Lessee/Age stdinattilre of Contractor/Li nse Hold
STATE OF FLORJDA STATE OF FLORIDA ,
COUNTYOF COUNTY OF
The forgoing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
thisa� day of -' RRA 20 _Dby thisa2�S day of .20 by
(Name of person acknowledging)- _ (Name of person acknowledging)
{Signature of Notary Publi -State of Florida, G���� oi�0�6 (Signature of Notary Pub c-State of Florida, G\vENs oc\aa
NSP S`a�e ,�6?, 216
Personally Known OR Pro d t3`f� �ificat�iai?Sf �o. Personally Known O�,PFrf"ucedQ tifi�L�
Type of Identification Produce �- ° �Q`�o EE ,a�1 Type of Identificatio Prodced, owp' 65 Ssa•
'N° God�\sS�o°Na��°oa o` '.._Ml s om `ss�0 Na��ooa�ir N°�
Commission No.CSG _ �`yo�`�� Commission No.
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS