HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: 1. �`� Permit Number:
.-�., RECE1'.' -D JUL 18 2016
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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:_ To Select from dropbox, click arrow at the end of line !A
PROPOSED IMPROVEMENT LOCATION:
Address: .5563.Kbieguard Rd
Legal Description:
Property Tax ID#:,1309-321-0001-000-4 Lot No.
Site Plan Name: Block No..
Project Name:
Setbacks Front Back: Right Side: . Left Side:
DETAILED DESCRIPTION OF WORK:
Provide Sub panel in-Shop with switch, light, and receptacle
CONSTRUCTION INFORMATION:
Additional work tobene orme under this permit–c ec a appy:
HVAC LJ Gas Tank ❑Gas Piping Shutters ❑,Windows/Doors
ZElectric ElPlumbing ❑Sprinklers ❑Generator O Roof'
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer —Septic Building Height:
OWNER/LESSEE:. CONTRACTOR:
Name Micheal Harrison and Diana Harrison Name: Lawrence Stubbs
Address:5563 Kobleguard Rd Company: S&W Electric Inc
City: Ft.Pierce State:FL Address: 501 West Cpker Road
Zip Code: 34949 Fax: City: Ft.Pierce State:FL
Phone No, Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
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.
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 TITLEHOLDER: _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 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.
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
commencipg work or record"n ur Notice of Commencement.
S
Lfgignature of Owner/Lessee/Agent SigrKture of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA.
COUNTY OF c COUNTY OF !S;�.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Vt day of �S.J 20\!�_by this\day of_� 1i�J 20 A--by
(Name of person acknowledging) (Name of person acknowledging)
(ignature of Notary Pu c-State of Florida) _ (Signature of Notary blit-State of Florida)
Personally Known OR ProducpdJd"h ifd tte Personally Known OR Pro&ced Iden i�jc ib
Type of Identification Pro�dyced}— N to o1 F 6 Type of Identification Produced_ �^� QI ,1�VERS ` a
' '�C�o olacYP°b nes Deo5a�6i � 1�c Sta1e�0 F6,20i6
Commission No. < . 6 P es Der,i
MY D°cnsn EE No1acY Assn• Commission No. 1 e c Notary �g
teen#EE 858761
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nq -•',. °�`- 1 Notary
Revised 07/15/2>014' =r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS