HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a Permit Number: I
Building Permit Application OCT 2 6 2016
Planning and Development Services
Building and Code Regulation Division PERJIITTI,NJG
2300 VirginidAvenue,Fort Pierce FL 34982 St. Lucie County, i=L-
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Electrical
PROPOSED INPROVEMENT LOCATION:
Address: `
Legal Description:
Property Tax ID : - 3414-501-1701-000/9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be perrormedunder tis permit—check all appy:
HVAC LJ Gas Tank Gas Piping _Shutters Q Windows/Doors
nElectric ElPlumbing Sprinklers Generator EI Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor.
Cost of Construction:$ �Oo_ o Utilities:D Sewer Septic Building Height:
OWNERAESSEE: 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 SL Lucie She. FL
Phone No. 772-878-5513 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
tfvalue of construction is$2500 or more,a RECORDED Notice of commencement is required.
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S,UPPLEMENTALCONSTRUCTION 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: r/Not Applicable
ame: Name-
A ddress: Address•
Y: 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,penmit.
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 covenant,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
commencing work or recording our notice of Commencement.
Sig0fure of Owner/Agent/Lessee Si ure of Contractor/ 'cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
the forgoing instrut was -ad owledged_before me The forgoing instrument was cknowledggd before me
thi " ay of m 20 L(
by this2Mday of ::d 20-ZA—,by
(Name of person acknowledging) (Name of person acknowledging)
A4
( 'ture of Notary Public-State of Florida {Signature of Notary Public-State of Florida}
Personally Known ✓OR Produced Identification Personally Known t--- OR Produced Identification
Type of Identification Produced Type of Identification Produced
4Marr JULIET LAW
Commission No. Fr � NOTARY PUB (Commission No. F,��lG i� Y PUBLIC
STATE OF FL STATE OF FLORIDA
-WIT' Expires 1012 M16 whWEERM
Revised 07/15/2014 Expires 10/28/2016
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
1DATE
1 ;COMPLETED
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