HomeMy WebLinkAboutELECTRIC - RESIDENTIAL All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: \ 31 Permit Number:
RECEIVED OCT 23 1015
` � .. .. 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: _
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PROPOSED`INPROVEMENT LOCATION
Address: ti`s
Legal Description: i
Property Tax ID#: ��-2�Go 0/ O 0 0 0�i Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE5CRIPTION OF WORK
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C%1e,,e/r-r C. CA_,J* 1- p v�S�'C�' T h C U Se I'—'Gr/
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CONSTRUCTION INFORMATION
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Additional work to be pe orme �under this permit-c ec 7a t at apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
X Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OV1%NER/LESSEE CONTRACTOR w
a
Name G v o c r Name: ��Y l
Address: // �-/ 1����iiv� �Jv� 6I� Company: Cylr� c� r✓��c�d 't �
City: -5-/u 1:6-0 e J' State:(2�4 Address: G //r✓t
Zip Code: c! /Jw Sr Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No Z_—5 / 3
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License CC /30c;�S-3 '7.S'
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEIVIENTAL CQNSTRUCT10 LIEN LAW INf=QRMATION
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
commencing work or recording our Notice of Commencement.
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Signature of Owner/Less gent Signature of Con0re0ticense Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF �_ �- il \'� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this'�� day of d c ,20 15 by this Q3 day of a 4zz�r 20�5 by
5o T s-e. 6 ( a,r��1�`\ a 50-c- Ate. 6r( al,,.ckd1\�1 ZS
(Name of per on acknowledging) (Name of per on acknowledging)
(Signature of Notary Pubi -State of Florida) (Signature of Notary Pu ic-State of Florida)
Personally Known OR P ced 1,1 jj ic!'n Personally Known O Pr2duce' �flea��, °.
Type of Identificatio State of FlOf' Type of Identificatio State of
Produced L ,,�iY'PUa,;,, Notary Public 16 ;•P v a�ecc, Notary PubEXpires Dec 16.2016
_ Cxpires pec 16.20 Produced L-
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- ission p«n ' = Dommission trona)N°tary Assn.
Commission No. `' = DO ����National Ncl� , , Commission No.�E `- jS��W� •- ""'
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014