HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED-
Date: f C;W/z� - Permit Number:
RECEIVED
Building Permit Application
SEP 13 2016
Planning and Development Services
Buflding and Code Regulation Division
2.900 VirVinia Avenue,Fort Pierce FL 34982
Phone:i(772)462-1553 Fax:(772)462--1578 Commercial Residential X
PERMIT APPLICATION FOR: Electrical
PROPOSED INPROVEM ENT LOCATION:
Address;
Legal Description:
Propert�TaxlD* 1306-111-0001-0001--) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Frorrt_ Back-_Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
Replace meter center with a combo pack
CONSTRUCTION INFORMATION:
dition I oris er t is permit—c e a Itapply:
0HVAC GasTanl( E]Gas Piping —Shutters OW!ndows/Doors
LTJElectricUPlumbing 0Sprinklers 01 Generator Roof
Total Sq-Ft of Construction: SQ_Ft.of First Floor
Cost of construction:$ cast 0, 06 Utilities Sewer R Septic Building Height;
OWNER/LESSEE: CONTRPiCTOR:
Name Wynne Building Corp. Name: James W Law
Address- 8000,S US#I Suits 402 Company: Law's Electric,Inc.
City. Port St Lucia State: FL Address- '218 Beach Avenue
Zip Code: 34952 -- Fax: City: Port SL Lucia State: FL
Phone No 772-878-5513 Zip Code: 34952 Fax: 772-878-3347
E-Mail- Phone No. 772-971-4512
Flawselectiitinc@_aol.com
Fill in flee simple Title Holder on nextpage(if different E-Mail-
from the Owner listed above) State or County License: ER0000122
1 11
if value of construction is$2500 or more,a RECORDED Notice of CornmencementTs required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: IlNot Applicable
Name: Name:
Address. Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLit TITLE HOLDER: Not Applicable BONDING COMPANY: r/Not Applicable
Name: I Name:
Address: I Address:
—
City: I City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St Lucie Counter 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 exemptfrom 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 recordingyour Notice of Commencement.
Si re of;Owner/Agent/Lessee Si tune of Contractor/cense Holder
STATE OF FLORIDA � ,,DD STATE OF FLORIDA f
COUNTY OF A `,�S,Gf�".t COUNTY OF
The fore ing instrument was acknowledged-before me The forgoing instrument was acknowledged before me
thia. day of 20��by this, day of ,ra 7f' 2Dl-,by
(Name of person acknowledging) (Name of person acknowledging)
i
(Signature if Notary Public-State of Florida) (Signa-16nitif Notary Public-State of Florida)
Personally1Gnown v""' OR Produced Identification Personally Known ✓OR Produced Identification
Type of Identification Produced Type of Identification Produced
JULIET LAW JULIET LAW
Commission No. :STATEE�OFFL
TPUB IOommission No. fr'!Jd 9d NOTARY PUBLIC
R1DA STATE OF FLORith
Expires 10/28/2016 ftires 10128-2-
Revised 07/15/2014
I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW. REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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