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ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: -.y1'i. �9 �� Permit Number: C�Qia o�)3,7
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial I' Residential X
RERMIT APPLICATION FOR: Electrical
P:RO'P0-5-ED tI-PR0VE ENT LOCATION:
Address:
Legal Description•
Property Tax ID#: 3414501-1701-000/9 Lot No.
;Site Plan Name: Block No.
Project Name:
I I.
'Setbacks Front Back: Right Side: Left Side:
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CkE7` L b_LSCRIP1'CON 01=a1ORK:'. :
Replace meter center with a combo pack I,
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CONST-R-P T[ON INF ORMATOM-
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Additional work to (e�e orme under tispermit—c e— a appy:
❑HVAC 3_J Gas Tank Gas Pi in Shutters Windows Doors
Electric 1:1 Plumbing Sprinklers Generatorl '_Roof
Total Sq. Ft of Construction: SQ.Ft,of First Floor:
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ost of Construction:$ f>O, o0 Utilities: _Sewer❑Septic Building Height:
1Nl VL.ESEE CONTRACTOR .
ame Wynne Building Corp. Name: .lames W Law;
ikddress8000 S US#1 Suite 402 Company: Law's:Electdcj Inc.
ity: Port St. Lucie State: FL Address: 21813each Avenue
Zip Code: 34952 Fax: City: Port St. Lucie' State: FL
Phone No. 772-878-5513 Zip Code: 34952Fax: 772-878-3347
E-Mail: Phone No. 772-971-4512
�1111 in fee simple Title Holder on next page(if different E-Mail: Iawselectricinc@aol.com
from the Owner listed above) State or County License: ER0000122
1 value of construction is$2s0D or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
1-E IGNER/ENGINEER: s/ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
Cly: State: City: State:
ZIP: Phone: Zip: i;Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: I Not Applicable
Nacre. Name:
Address: Address:
City: Olty: I.
Zip: Phone: Zip: Phone:,,.
certify that no work or installation has commenced.prior to the issuance of a permit.
St.Lucie Comer makes no representation that is granting a permit will authorize thegermit holder to build the subject structure
Which is in conflict with any applicable Home Owners Association rules,bylaws or an covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed far any restrictions winch may apply.
in consideration of the granting of this requested permit,I do hereby agree-that I will,in all respects,perrarm the work
in accordance with the approved pians,the Florida Building Codes and St.Lucie Courrty 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 ari attorney before
commencing work or recording our Notice of Commencement.
Sgna re of Owner/Agent/lessee gnature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
'COUNTV-OF SAINT WCIE COUNTY OF L SAINT L;UCIE
The forgoing instrvinentwas acknowledged before me The forgoing instrument was acknowledged before me
this day of d . Z0 Z6by this, da11 of pQa!r .f .20� by
i,
.JAMES W LAW JAIME.. S W LAW'
!(Na person admow ging I (Mame person adrnowleaging)'
(Signature of Notary Public State of Florida) (Si ature of Notary Public-State' Florida)
!Personally Known OR Produced Identification Personally Known, 6--"'OR Produced ldentfication
Type of Identification Produced Type of Idenlif9cation Produced
.!Commission No. 1�F� ��� (Seal) Commission No. I'�f FW. (-3 (Sea[)-
v,
Seal)"' • ANNE BROWN W MACH
•: MY COMMISSION#FFSW63 WN WAI RAACH
EXPIRES MY COMMISSION#FF
Revised 07/15/2014 April 21,2020 _^ 984683
r407 39MJ63 FlaridOoM to Amp EXPIRES
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