HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. Permit Number.
x ' RECEI','-D SEI' 0 6 2016
Building Permit Application
Planning and DevelopmenrServices
Building and Code Regulation Division _
2300 Yrginia Avenue,Fart Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Electrical a
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: 1301-111-0001-00015 <?,L Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Sack: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
Replace meter centerwith a combo pack
CONSTRUCTION INFORMATION:
Adartionalworktoperierrormed under tis permit—c ec all appy:
HVAC Gas Tank E]Gas Piping Shutters ❑Windows/Doors
PlElectric Plumbing Sprinklers a Generator E]Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ :L,20. lttilities:0SewerSeptic Building Height:
OWN E R/LESSEE: CONTRACTOR:
Name Wynne Building Corp. Name: James W Law
Address: 8000 S US#1 Suite 402 Company: Law's Electric, Inc.
City: Port St.Lucie State: FL Address: 218 Beach Avenue
Zip Code: 34952 Fax: City: Port St.Lucie State: FL
Phone No. 772-B78-5513 Zip Code: 34952 Fax: 772-878-3347
E-Mail: Phone No. 772-971-4512
Fill in fee simple Title Holder on next page(if different E-Mail: lawselectricinc@aol.com
from the Owner listed above) State or County License: ER0000122
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
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SUPPLEMENTAL CONSTRUCTION LEEN LAIN INFORMATION:
D.ESIGNER/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: r,--Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
"NER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
licertify that no work or installation has commenced prior to the issuance of a permit
St Lucie County makes no representation that is grant-mg 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 exemptfrom undergoing a full concurrency review:room additions,
a"ccessorystructures,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 Comn'iencement 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
c�mmencin work or recordingVour Notice of Commencement.
�gvyure of Owner/Agent/Lessee Sigliature of Contractor/ 'cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ;.Gf,P�. COUNTY OF aZ-/ /�a
i
(he forgoing instrument was acknowledged_before me The forgoing instrument was acknowledged before me
his_day of_ axa .2Q,C�by this day of ��,�f' .20�by
(Name of person acknowledging) (Name of person acknowledging)
_ \
{ a e of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known 4-1OR Produced Identification Personally Known ri OR Produced Identification
Type of Identification Produced Type of Identification Produced
�y JULIET LAW EARY
Commission No. �_� G9�.z NOTARY PU8 Mommission No. E *6�Db y APUBLIC
S FATE OF FLTE OF FLORIDA
COMM*E
Expires 10/28!2016 Expires 10/28f2016
Revised 07/15!2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
JILDTEAOMPLETED
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