HomeMy WebLinkAboutBuilding Permit Application SA PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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.
�/�-- r t S
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
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STATE OF FLORIDA «
�S = STATE OF FLORIDA
COUNTY OF —2"t COUNTY OF
The fa ping instr ent was acknowledged befo x The forgoing instrument was acknowledged before me
this y day of 20/Lby -"' this day of 20 by
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(Name of person acknowledging) z *;sib` (Name of person acknowledging)
(Signature of N§ ary Public-State of Flo da} (Signature of Notary Public-State of Florida}
Personally Known ORP duped Id tifica 'on Personally Known OR Produced Identification
Type of Identification Produce Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALST--
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rf
Date. April 9,2016 Permit Number:--��� 0
y f
REcEIVED
Building Permit App �ja ion , ,
Planning and Development Services AI - � 2016 �
Building and Code Regulation Division
i
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential xx
PERMIT APPLICATION FOR: Electrical 0
PROPOSED IMPROVEMENT LOCATION:
Address: 6100 Buchanan Drive, Fort Pierce
Legal Description: Indian River Estates-Unit 02- BLK 11, Lots 17, 18 and 19
Property Tax ID#: 3402-603-0141-000/4 Lot No.
Site Plan Name: Block No.
Project Name: Workshop Electrical
Setbacks Front Back: Right Side: Left Side:
[ ETA tED DESCRIPTION OF WORK.
Installation of overhead lights, light switch, outlets and breaker panel in a workshop located in the
back of the property_ _ . 5e r-v ce- W , (-te. ,
Lk A&r'4 rc7ur C� . .4rV
-
CONSTRUCTION INFORMATION
Additional war toe performed under this permit—c ec all that appy:
HVAC 0 Gas Tank Gas Piping _Shutters F Windows/Doors
EElectric ❑Plumbing Sprinklers R Generator Roof
Total Sq. Ft of Construction: _ Sq. Ft.of First Floor:
Cost of Construction:$_ (J 0. Utilitiesn: Sewer LJ Septic Building Height:
OW NRf LESSEE•, CONTRACTOR:
Name Elizabeth L. Brown Name:
Address:6100 Buchanan Drive Company:
City: Fort Pierce State: FL Address:
Zi Code: 34982 Fax: City: State:
Phone No.772-971-0943 Zip Code: Fax:
E-Mail: brownliza@bellsouth.net Phone No.
Fill in fee simple Title Holder on next page(If different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$25OO or more,a RECORDED Notice of Commencement is required.
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
e '^ BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE ,
I FORT PIERCE,FL 34982 t Ii
(772)462-1553 Fax(772)462-1578
OCT 3 12016
PERMIT RENEWAL REQUEST PERMITTING
St. Lucie County, FL
PERMIT NUMBER: I lo0g O M ADDRESS: kin( u(: 69gfio p
I, L=l I zol y l 2 ro1 ,am requesting that the above permit be renewed. I
understand that I must Schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification (-C,h n YY\Q,Yre /
OWINER/BLf DR OR CONTRACTOR S-I SIGNATURE DATE
Print Name
STATE OF FLORI A
COUNTY OF
ACKNOWLEDGED BEFORE ME THIS DAY OF 20j Ca_
BY Q:)%\I�� WHO IS PERSONALLY KNOWN TO ME ,OR
HAS PROVIDED — .L, AS IDENTIFICATION.
STATE OF FLO A,Co ty o
�m ®4. ("IF 1 0 "�; KAREN S. NIELSEN
°�UilY�n
SI ATU F ARY Comm"AU p FF 115637
My Commission Expires
`` June 12, 2018
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open = $ Renewal fee
Example: [15 divided by 23=.65(%)] $175(permit fee)x.65=$113.75(renewal fee)
Revised 7/21/2014