HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit ! r— Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential momxx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: U
Legal Description:
Property Tax ID #: i - S7 p / - 0 v - 0 a G r8, Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Block No.
remove existing pedestal install new :. 4 rstO Y;1 4'�` Wi !-' fr,+,,r,c rriF�4i r4- Y' cC
e-, �A A ` /+Ivy. -C+Avi4
CONSTRUCTION INFORMATION: -
Additional wor to e eorme un er t is permit - check a apply,
Gas Tank ❑Gas Piping OGenerator
Shutters I]Windows/Doors
Electric Plumbing Sprinklers 1:1 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ / 3
S. Ft. of First Floor: _
Utilities: Sewer El
Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 191 4 n 1G l
Name: John R Law
Address:_ / U 7.2, S7 _ e) r sy f, rill
Company: Law's Electrical Service Inc
City: __7r F�Sc�, r2x,t-I, State: i-`1
Zip Code: 3 `d 9 S 7 Fax:
Phone No. c - G� - '�/ _C-4-1 L(
Address: 5158 NW Primm St
City: PT ST Lucie State: FL
Zip Code: 34983 Fax:
Phone No. 772 370 4357
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: johnlaw5158@aol.com
State or County License: 29432
.z .?c aver ur rI ILAC, a 1%r%-%J1%iJCU IVOLCe OT Lommencenlent Is recluirect.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name: _
Address:
City:
Zip:
INEER: Not Applicable
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
cip: Phone:
State:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY; Not Applicable
Name:
Address:
City:
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 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 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; your Notice of Commencernpnt
SJ_ Signa re of owner/ Lessee/Agent
TAE OF FLOR
COUNTY OF �Q
The forgoing instrument was acknowledged before me
this day of 4
4gaL___, 20 !i?by
�.
(Signature of [Votary Public- State of Florida }
Personally Known OR Produced Identification
Type of Identification Produced
My COMMISSION # FF984663
s
signature ontractor/License Holder
STATE OF FLOR DN
COUNTY OF
The forgoing instrument was acknowledged before me
this I day of20 _L2 by
(Name of person acknowledging)
—0 1, �Gi4ct) G
(Signature of Notary Public- state of Florida)
Personally Known _X_ OR Produced Identification
Type of Identification Produced
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
COUNTER
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
a `.1663 (Seal)
ANNE BROWN �+u-�~ , . �'
�!Y COMMIS sin, # _1=_84663
EXPIRES aPri121 2020
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VEGETATION I SEA TURTLE 711ANGROVE
REVIEW REVIEW REVIEW