HomeMy WebLinkAboutBuilding Permit Application ALL APP ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
"� o�C�/�o Permit Number: ILI?�
RECENED
Building Permit Application
Planning and Development Services SAN 2 5 2016
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: Electrical
PROPOSED INPROVEMENT LOCATION:
Address: 4�
Legal Description:
Property Tax ID 4: 3414-501-1701-000/9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace meter center with a oombo pack at each address
CONSTRUCTION INFORMATION:
rtiona wor to e e rme uncierthrs permit—ctieck all that apply:
❑HVAC OGas Tank DGas Piping _Shutters ❑Windows/Doors
Lel Electric 0 Plumbing Sprinklers 0 Generator Roof
Total Sq.Ft of Construction: 5 Ft.of First Floor
Cost of Construction:$ 4 e) O C�.�y Utilities: El
Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Wynne Building Corp. Name: .lames W Law
Address:. 8000 S US#1 Suite 402 Company: Law's Electric,Inc.
City: Port St Lucie State:FL Address: 218 Beach Avenue
Zip Code: 34952 Fax: City. Port St.Lucie State: PL
Phone No. T72-878-5513 Zip Code: 34952 Fax: 772-878-3347
E-Mail: Phone No_ 772-971-4512
Fill in fee simple Title Holder on next page(if different E-Mail: lawselectricinc@aol.eom
from the Owner listed above) State or County License: ER0000122
if value of construction is USOO or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESfGNERjENGtIVEER 1 NotApplicable MORTGAGE COMPANY: ✓ Not Applicable
Name: Name:
Address: Address:
City. State: City: State:
Zip: Phone- Zip: Phone:
FEE SIMPLE TITLEHOLDER: _j/ Not Applicable BONDING COMPANY: Not Applicable
Name. Name:
Address: Address:
City: may:
Zip: Phone- Zip: Phone-
I certify that no work or installation has commencedpriorto the issuance of a permit
St.Lucie Caunty makes no representation that is granting apermit will authorizethe permit holderto build the subject structure
which is in conflict with any applicable Home Owners Assodation 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,l do hereby agree that 1 will,in all respects,perform the work
in accordance Wah the approved plans,the Florida Building Codes and St.Lurie 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
lmprovemenfis to your property.A Notice of Commencement must be recorded and posted on the jobsrte
before the first inspection.if you intend to obtain financing,consult with lender or an attorney before
commencing work or recording aur Notice of Commencement.
Signa re of Owner/Agent/Lessee nature of eontractorlLieense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SAINT LUCIE COUNTY OF SAINT t t9C1E
Theforgoing instr entwaa arknmidedged b re me Thefor�eai g instrU ent was acknowledged before me
ttiisday of 'ZO by thi. day of 2[3.�¢'by
TAMES W LAW JAMES W LAW
(Name of person acknowledging) (Name of person acknowledging}
(Sign f!Votary Public-State of Florida} (Signature otary Public-State of Florida
Personal Known V' OR Produced Identification
Personalty Known OR ProducedIdentsficatton . Type of identification Produced
Type of Identification Produced _ JULIET LAW
EE 846906 NOTARY PUBLIC 'EENo. EE 845906 AtiY PUBLIC
Commission No. — ATE OF FLORIDA STATE OF FLORIDA
Ebiplm� 1012810 Comm#EEtS469D8
Expires 10/26!2016
Revised 07135/2014
REVIEWS CFRONT ZONING FRO
OUNTER REVIEW 5 REVIEW REVIEW
REVIEW PLANS VEGETATIONS REVIEW REVIEW
TURTLE MANGROVE
DATE
COMPLETE
IiNll'IALS
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