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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: —/�l ���6 Permit Number:
Y ,� z RECEIVE®
•
Building Permit Application ,APR t 8-% 2016
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
PROPOSED IMPROVEMENT LOCATION:
Address:,904 Buckeye Drive
Legal Description:
Property Tax ID#: 3404-501-0528-000-4 Lot No.
Site Plan i Name: Block No.
Project Name:
Setbacks) Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace meter and fuse panel with 200 amp meter and-breaker panel and 2inch riser
CONSTRUCTION INFORMATION:
Additional work to be nertormed unclertnis permit—check all appy:
_ HVAC Gas Tank Gas'Piping Shutters. ❑Windows/Doors
..❑ I
✓_" Electric Plumbing Sprinklers ElGenerator Roof
`:Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 2000 Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Helen Marshal Name: Lawrence Stubbs
Address:4032 Greenwood Drive Company: S&W Electric Inc
City: Fort pierce State:FL Address: 501 W.Coker Road
Zip Code j� 34982 Fax: City: Fort Pierce State:FL
Phone Noir 772-446-2699 Zip Code: 34945 Fax: 464-4273
E-Mail: 1 Phone No. 464-6466
Fill in fee simple Title Holder on next page(if different E-Mail: stuboutelectdc@aol.com
from the Owner listed above) State or County License: 29442
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL 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
commeming work or recording our Notice of Commencement.
/ 'O�~'�•'*•Nab'
Signature of Owner Lessee/Age t = Si ttire of Contractor/License Holder >; .
STATE OF FLI STATE OF FLORI!%6
COUNTY OF r^-< COUNTY OF
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The f y ing instru ent was acknowledged of ern < The f• ing instr nt/,w�as�acknowledged efore me 2.X0 a
this 1-4)- of 20� b �" �o= this day of ✓ LAL' 20�&try 2��
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(Name of p
on acknowledging) COn, (Name of pers n acknowledging)
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(Signature of Notaubli�c-State of Florida) (Signature of Not Public-State of Florida)
Personally Known ' OR Produced Identification Personally Known/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
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