HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: 01/11/2016 Permit Number:
RECEIV77D JAN 12 2016
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 IMPROVEMENT LOCATION
Address: 1704 43rd St. Ft. Pierce, FL 34947 c 1
Legal Description: 5iV �,.Aio�, �eAe'L)s®� ���( W (� �04 ( Q
C n a tat �c�ov_- n us w 2-9 30
Property Tax ID#: la-td 10-506 -002-5 - 006 —6 Lot No.
Site Plan Name: 1� s Block No. W
Project Name:
Setbacks Front Back: Right Side: " Left Side: "�-
DETAILED"DESCRIPTI:ON OF*ORK
:
C��K NA �� FiK�v � ®SK- Quo
CON,STRUCTIQ`N INFORMATION
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Additional work to e e orme under this-permit-c ec a appy:
HVAC M Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
R]Electric ❑ Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: yy 3 1 S . Ft.of First Floor: �' 1
Cost of Construction:$ Pt®� Utilities:nSewer®Septic Building Height:�' 8
OWNER LESSEE- CONTRACTOR:
Name G"P_k-_tq. 46 .w& Name: Robert Koenekamp
Address: kA Company: East Ocean Electric of Florida, INC
City: herr State: Address: 3550 NW 8th Avenue, Unit 305
Zip Code: I{'� �� Fa/x� City: Pompano Beach State:FL
Phone No. 4�2.�- 4(s(0 - 43 g(n Zip Code: 33064-3008 Fax: 561-228-8374
E-Mail: 0 $4 Phone No. 561-889-0607
Fill in fee simple Title Holder on next page(if different E-Mail: eastoceane@yahoo.com
from the Owner listed above) State or County License: EC 0000187
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: P ne: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING Cf MPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Pho e:
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
orkin 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 int e d to obtain financing, consult with lender or an attor y before
commencing wo.k or recording you otice of Commencement
s
_
Sidn-aturV of Owner/Lessee/Agent Sign re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY O F PALM BEACH COUNTY O F PALM BEACH
The forgoing instrument was acknowledged efore me The for oing instrument was acknowledged before me
this day ofm OM 20 by thisday o 20 by
ROBERT KOEN"P ROBERT KOENEKAMP
(Name of person acknowledging) (Name of person acknowledging)
(Signare of otary Public-State of Florida) (Sig ature Notary Public-State of Florida)
Personally Known OR Prod c d identification Personally Known OR Produc I ntificatiq_
Type of Identi o uced Type of Identification Produced
�.4hRY Pv i, �
Commission Q2°. f6tary
RIS A.r��lj Commiss n Ro.„
_•« c blic- INGRIS-A.FLORES .
•cState of Florida
MExpires S =. *�• Notary Public-State of Florida
sion#FF 039856 ° Yomm. Expires Sep 12,2017
o:
Revised 02 ';onn�P�' Commission #FF 039856 _
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DATE
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INITIALS