HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /_ �1
Date: / /(o Permit Number: �(( t/ ��(J3o?V
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Building Permit Application SEP 19 tom
Planning and Development Services
Building and Code Regulation Division
2300 irrginia Avenue,Fort Pierce FL 34982
Phone:(772)452-1553 Fax:(772)452-1578 Commercial Residential x
PERMIT APPLICATION FOR: Electrical 0
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: 130 111-0001-000ie Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace meter center with a combo pack at each address
[CONSTRUCTION INFORMATION:
Additional wor toe nerformed under tispermit—check all tha appy:
DHVAC Gas Tank []Gas Piping _Shutters a Windows/Doors
Electric Plumbing []Sprinklers - 0 Generator a Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ /d—��• Od Utilities Sewer DSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Wynne Building Corp. Name: .lames 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. 772-878-5513 Zip Code: 34952 Fax: T72-878-3347
E-Mail: Phone No. 772-971-4512
Fill in fee simple Title Holder on next Page(if different E-Mail: lawselectdcinc@aol.com
from the Owner listed above) State or County License: E R000012-2
If value of construction is$2500 or more,a RECORDED Notice of Commencement N required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
4ESIGNER/ENGINEER: V Not Applicable
MORTGAGE COMPANY: -Ef'Not Applicable
lame: Name:
Address:
Address
State.
City-
state.
P.
Phone:
Pho�
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: v,Not Applicable
Larne: Name:
Address: Address:
C ty:
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 Coup makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in coxict with any applicable Home owners Association rules,bylaws or ancovenants that may restrict or prohibit such
structure.Please consult with your Home owners Association and review your deed for any restrict-tons which may apply.
In consideration ofthe granting of this requested permit,I do hereby agree that I Will,in 211 respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
T�e following building permit applications are axemptfrorn undergoing a full concurrency review.room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessary 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
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before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recordigg your Notice of Commencement.
tgofure of Owner/Agent/Lessee Slgfi-Aure of Contractor/ 'cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -ssCOUNTY OF
7�he forgoing instrument was acknowledge-d-before me The f6raoing instrumentwas acknawledgqd before me
lhiz.44dayof 2OZkby thkddayof 20/_6_-bv
(Name of person acknowledging) (Name of person acknowledging)
AX
of Notary Public-State of Florida (SignatureofNotary Public State of Florida
Personally Known Produced Identification Personally Known I-- OR Produced Identification
Type of Identification Produced Type of Identiflcation Produced
JULIET
'jKy CIET LAW
Commission No. A+ter.Jaj! ��g� NOTARY PUBtfCommission No.AFE&964 ffe aw-M&
STATE-OF FLCfPMA ITARY PUBLIC
r4min#FER"tim STATE OF FLORIDA J
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"WIPP Expires 1012=016
Revised 07115/2014 1=80116
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
IDATE
C MPLETED
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