HomeMy WebLinkAboutBuilding Permit Application ALL APPUCTABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED + t�
Date: -:1 2D rf' Permit Number:
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Bui Irk' ftkfiii' 'A� lication
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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 Residential X
PERMIT APPLICATION FOR: Electrical
PROPOSED INPROVE MENT LOCATION:-
Address:
Legal Description:
PropertyTax ID#: 1301-111-0001-00015 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
CONSTRUCTION INFORMATION:
AcIditional work toflasTank
orme under tis permit—c ec a appy:
HVAC ❑Gas Piping _Shutters E]Windows/Doors
Electric Plumbing Sprinklers F Generator 0 Roof
Total Sq_Ft of Construction: S Ft,of First Floor:
Cost of Construction:$ c�,JO O6 utilities:�Sewer�Septic Building Height:
OWNER/LESSEE: 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 St. Lucie State: 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: lawseleciiicinc@aci.com
from the Owner listed above) State or County License: ER0000122
if value of construction is$2Sa0 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: ,/ Not Applicable MORTGAGE COMPANY: ✓ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: P;Pone: Z71 p: Phone:
FEE SIMPLE TITLE HOLDER: „/Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
1 certify that no work or installation has commenced prior to the Issuance of a permit.
St Luse County 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 CountyAniendments.
The following building permit applications are exempt from undergoing a full concurrency review.room additions,
accessory structures,swimming pools,fences,walisy 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 jobsiite
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.
Sign re of Owner/Agent/Lessee gnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTVOF SAINT WCIE COUNTY OF SAINT LUCIE-
Theft—ping instrvm nt was acknowledged before me The fuming instrument was acknowledged before me
this—day of _ , 20 Zaby this flay of: .20,G!Z_by
I&MES W LAW JAMES W LAW
(Na person acknaw ging) (Mame person acknowledging)*
(Signature of Notary Public-State of Florida) (SikKature of Notary Public:State of Florida)
Personally Known ✓ OR Produced Identification Personally Known OR Produced Jdentrfication
Type of Identification Produced" Type of Identification Produced
Commission No. (Seal) Commission No-_f c j��C{re [$eal):
....
_ '• ANNE BROWN W MACH ..•�.,,
MY COMMISSION#FF9$4863 ?:; WN WALMACH
Revised 07/15/2014 EXPIRES Aryril 21.2020 �- MY COMMISSION#FF984663
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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