HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/25/2016 Permit Number:
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 X
PERMIT APPLICATION FOR: Electrical
Address: 12038 RIVERBEND ROAD, PORT ST. LUCIE, FL 34984
Legal Description: 12038 RIVERBEND ROAD, PORT ST. LUCIE, FL 34984
Property Tax ID #: 4422-502-0014-000-0
Site Plan Name:
Project Name: John Cairns
Setbacks Front Back:
RE -FEED DOCK PANEL
Right Side: Left Side:
Lot No.
Block No.
iamonal worK to pe errormea
HVAC Gas Tank
unser tnis permit– cnecK ail
[]Gas Piping
inat apply:
Shutters
❑ Windows/Doors
_
❑✓_ Electric ❑ Plumbing
❑ Sprinklers
Generator
Roof
Total Sq. Ft of Construction:
Cost of Construction: $ l,5DO.QC) _
Name JOHN S CAIRNS ETAL
Address: 12038 RIVERBEND ROAD
City: PORT SAINT LUCIE State:
Zip Code: 34984 Fax:
Rhone No. 772-971-2222
E -Mail:
SFt. of First Floor: _
Utilities. — Sewer F]Septic
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: GARETT GUIDROZ
Building Height:
Company: COMPLETE ELECTRIC, INC.
Address: 637 SEBASTIAN BLVD.
City: SEBASTIAN State: FL
Zip Code: 32958 Fax: 772-388-2411
Phone No. 772-388-0533
E -Mail: mhatfield@completeelectricinc.com
State or County License: EC0001911
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
State:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
SUPERVISOR
Address:
VEGETATION
City:
State:
Zip: Phone:
COUNTER
BONDING COMPANY:
Not Applicable
Name:
REVIEW
Address:
REVIEW
City:
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.
1 Iconsideration 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 vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF I rl Pt AA
The for oing instrument was acknowledged before me
this `i. day of 20 I (,by
��i�i �w (_ �'LLCI V -o
(N me of�eerson ack owledging )
(Signature of N ary blic- State of Florida )
Personally Known
Type of Identification Prod
OR Produced Identification
Commission No. F q0 91 Le
Revised 07/15/2014
1>R� otti Notary Public State of
aF .,&' �^ h9aridoll Hatfield
My Commisson r
'sof ,o Expires 09/1912019
Signatur of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
The forgoing instrument was acknowledged before me
this 25 day of FEBRUARY 20 _p by
GARETT GUIDROZ
(Name of person acknowledging )
(Signature of N to Public- State of Florida )
Personally Known x OR Produced Identification
Type of Identification Produced
No. FF 901564
s
Notary Public State of Florida
11 Maddoll Hatfield
c' o` My Commission FF 901564
'%lof nom Expires 09/19/2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS