HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: 01/11/2016 Permit Number: 1601- 514 1
• a I C a RECEIV D 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
PRO POSED'IMPROVEMEN LOCATIO.N: :.
Address: 3400 Avenue K, Ft. Pierce, FL 34947 `` ,�,,,11
Legal Description: ��ia,�- - Soo ���d Cc)K1�A&_Os m s9 wT 66
( p o k8 NC
Property Tax ID#::� - oo /ii— coo -9 I Lot No. �6
Site Plan Name: V.J`c �\ {1�e�S. Block No.
Project Name: Cj
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
u �
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank
❑_ ❑Gas Piping Shutters ❑Windows/Doors
Electric Plumbing Sprinklers _Generator
Roof
Total Sq. Ft of Construction: 1 ` \o S . Ft.of First Floor:
Cost of Construction:$ T�� Utilities.. ®Septic. Building Height: O
OWNER/LESSEE: CONTRACTOR:
Name G 4Q t k-%�� Name: Robert Koenekamp
Address: 'A00 lWe,00 Company: East Ocean Electric of Florida, INC
City: 00 State: f Address: 3550 NW 8th Avenue, Unit 305
Zip Code: 5ACI Fax: City: Pompano Beach State:FL
Phone No. 4 -24 — -4 QQ -q ` Zip Code: 33064-3008 Fax: 561-228-8374
E-Mail: Q f IN 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 COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: X 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 inte to obtain financing, consult with lender or an attorney b re
commen,
,cJng work or recording our otice of Commencement.
s
_Si nature of Owner Lessee/Agent Signatur of ontractor/Li ense Holder
STATE OF FLORIDA STATE-OF FLORIDA
COUNTY O F PALM BEACH COUNTY O F PALM BEACH
The for oing instrument was acknowledged before me The forgoing instrument was acknowledge fore me
this �� day of 20 M, this Z—day o 20 by - -
ROBERT KOENEKUIP ROBERT KOENEKAMP
(Name of person acknowledging) (Narrie'of person acknowledging)
(Sigotury
Notary Public-State-of Florida) (Signature otary Public-State of Florida)
Personally Known OR Prod c IdentificationPersonally Known OR Produ dentificatiof
Type of Identification Produced 6
'Type of Identification Produced ��
Commission No. mission No.
320;"FVPiB��; INGRIS.A.FLORES .•``aY�P'u'' 1526017
* + Notar ,oP B`�=y Comm.Ex fres Sep 12,2017 * M C7* n oe, yRevised 07/15/2014 %; Commission#FF 039856 °;rF o ••' Co
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