HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1-0)- I lv Permit Number:� 0
M RECEIVE®
Planning and Development Services Building Permit Application
DEC 15 2016
Building and Code Regulation Division PtiRMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Luc ie County, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Electrical
PROPOSEDflN1PRO\/EMENT LOCATitJN Y
Address: 16265 Carlton Adams Rd. FortPierce,FL 34945
Legal Description: LUKE'S LOTS(PB 41-4)LOT 8(7.552 AC)(OR 3723-223)
Property Tax ID#: (JtJ' �® Lot No.
Site Plan Name: Baran Residence Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE5CRIRTION1QF WORK
,
Install circuit for gate motor and column lights and hook up
CONSTRPCTION INFORMATION; ` E
Additionalwork to be pertormeclunclertnis permit—c ec^al I appy:
HVAC I_1 Gas Tank ❑Gas Piping _Shutters �Windows/Doors -
ZElectric 0 Plumbing Sprinklers a Generator g Roof C� Roof pitch
Total Sq.Ft of Construction: SCI.
of First Floor:
Cost of Construction:$ 2,375 Utilities:l_I Sewer Septic.; Building Height:
Name Jason R.Baran Name: Charles Hoppmann.
Address:16265 Carlton Adams Rd. Company:.Bellwether Electric Company
City: Fort Pierce State:FL Address: 571 NW Mercantile PI
Zip Code: 34945 Fax: City: Port St. Lucie State:FL
Phone No. Zip Cade: 34985 Fax:
E-Mail: Phone No. (772)621-9494
Fill in fee simple Title Holder on next page(if different E-Mail: bellwether.elect(c@gmail.com
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r.y
1 0
3 0 ,
from the Owner listed above) State or County License: EC4122
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL C0NSTRUCTION,LI N LAW INFORMATION
DESIGNER/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: _Not Applicable
Name: Name:
Ad d ress: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
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 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 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
b ore the first inspection. If you intend to obtain financin consult with lender or an attorney before
XonlVencing work or recording our Notice of Commencpment.
(- ��111 a�!LA"__ � 601�-�_ __
s
e of Owner/Ea /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST L11.C1 COUNTY OF 9'1'. Ldd GtE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 41 day of NOV_ 20 it-by this1=1 day of No V• 20 V. by
1
(Name of person ackno ledging) (Name of person acknowledging)
(Sigribfure of Notary WbU--State of Florida) (Signa re of Nota lic-State of Florida)
Personally Known y OR Produced Identification Personally Known V" OR Produced Identification_
Type of Identification Produ Type of Identification Prod _
' DAVID JURKIGWIC CC �"� .=, DAVID IJ1JRKIEWICZ
Commission No. '= MS0MMISSION#FF998 O8o mission No. 'e MY ASTON#FF998909
''•,ql�a�,.• EXPIRES June 05,2020 -'4:' EXPIRES June 05,2020
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Revised 07/15/2014
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