HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICAT110m TO BF ACCEPTED
Date: 811 8f201 6 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Comrilercial Residentia
Phone: (772) 462-1553 Fax: (772) 462-1578
FEl T APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 13797 A&B S Indian River Drive Jensen Beach, FL
Legal Description:
Lot No._
Property Tax 10 #: 4509-801-00,13-000-7
Block No.
Site Plan Name:
Project Name: Rich Back: _ Right Side: — Left Side:
Setbacks Front_
DETAILED DESCRIPTION OF WORK'
4 --
lo
CONSTRUCTION INFORMATION;
6
+innntxhinrk,tnnpnprrorm�p- �Unerthis permit— cr
[]Gas Piping
OSprinklers
0HVAC U Gas Tank
nV1 Electric El Plumbing
Total Sq- Ft of Construction:
<
Cost of Construction- , 20W00
all tn3l apply:
0 Shatters L1 Windows/Doors
0 Generator 11 Roof = Roof pitch
Sq. Ft, of First Floor: _
utilities:5ewer OSeptic
OWNERAESSEE:
NameKatherine M Rich
Address: 10305 S Indian River Dr
City: Ft Pierce State:FL
Zip Code: 34922 Fax:
Phone No.
E -Mail:
rill in fee simple Title Holder on next page ( if different
from the Owner fisted ab ovej
Building Height,
game: Frank Fitzpatrick
Cornpany: Alfred Bressaw Electrical Cont Inc
Address. 654 NE Dixie Hwy
City: Jen5un f3caGh State; FL
Zip Code: 34957 Fax: 772-334-8776
Phone No- 772-334-4014
p -mail- abressaw@hotrnaii.com
State or County License: ECO000915
If VAue of construcf= is $2500 or mwe, a RECORDED Notice of Cornmerx*rwft k r"Ujfed,
SUPPLEMENTAL CONSTRUCrtON UEN LAW INFORMATION:
-E-GNIEJJE�G11N-4E�E :
�
— Nltat Applicable MORTGAGE COMPANY: Not Appkable
Name:
Address:
Address:
State:
State: City:
State:
City:
Zip: Phone:
Zip: l'E��e-
FEE SIMPLE WLE HOLDER:
� Not Applicable BONDING G COMPAl Y: E�4�t Applicable
t�arr;e:
Warne:
address:
Address:
city_
City:
Zip: Phone:
Zip phone:.
I certify that no wart, or installation has commenced prior to the issuance of a perrnit.
St. Lucie Ccporit "es no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in ccn ct with any applicable Home owners Associatitn rules, bylaws or and covenants that rimy restrict or prohibit such
structure. Please consult with your Horne 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,
accessary 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 Year 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
rnmrinorrcine viork or recording your Notice of Commence
Signature of t +mer/ LesseeJAgent
STATE OF FLOR90A_
COUNTYOF
The ing instr # ,a dge before me
thi ay of _ aQ , by
(tame of person acknowledging) r
of Rotary Public- Mate of
Personally Known ns. -d" -` OR Produced identification
Type of 1dA i �n rndiP� a
A Notary Publics State of Florida
(seal)
My commission FF 012576
o. pad Expires 0 512 112 01 7
Rcvis 07/1512014
STATE OF fl3DA%1-,.r f 1"
ff
Co .; 3` ,,
The �ing instr nt s c ed before me
th day of e 20 by
(Marne of person acknowledging)
(Signature of Notari Pubfic- State of � da )
Personally Known OR Produced identification
Type of Identifir dy^
A av Notary Public State of Florida
Commission No
o
Dianna Knight(Seal)
y Lommission FF 0lz5as
eeg 4x{ ires 0512112017
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DATE
COMPLETE
INITiAE.S