HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4162-1553 Fax: (772) 462-1578 Commercial Residential xxxxxx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION.
Address: Z o U 1 -
Legal Description:
Property Tax ID .#: ` 1 G� SA U ! 7 C� �% C} v f Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: night Side: Left Side:
DETAILED DESCRIPTION OF WORK.
remove existing pedestal install new
CONSTRUCTION INFORMATION:
AOclitional work to be performed under this permit —check all apP y:
HVAC Gas Tank ❑Gas Piping OGenerator
Shutters Windows/Doors
LJ ElectricPlumbing Sprinklers Roo€
Total Sq. Ft of Construction: S of First Floor:
C'
Cost of Construction: $ " t , (-A Utilities: L]SewerE]
Septic Building Height:
OWNER/LESSEE:
Name v,4f"I H -c
Address:2 1 03 rL
City: S t` { s, ,.� _ State: _�,C_
Zip Code: L Fax:
Phone No. 7 7.
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: John R Law
Company: Law's Electrical Service Inc
Address: 5158 NW Primm St
City: PT ST Lucie State: FL
Zip Code: 34983 Fax:
Phone No. 772 370 4357
E -Mail: johniaw5158@aol.com
State or County License: 29432
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTfON LIEN t AW INFORl+ilIATION
DESIGN ER]ENGINEER; ^Nat Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Address:
Name:
City:
State:
Address:
Zip: _ Phone:
ZIP' State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: �`
BONDING COMPANY: Not Applicable
Address:
Name:
City:
Address:
Zip: Phone:
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 Horne 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 workorrecording your Notice of COmn,Pnrarnnn+
_ Signa re of owner/ Lessee/Agent
STA E OF FLOR
COUNTY OFA � L ' [' ( +
The forgoing instrument was acknowledged before me
this ; day of 20 1_)by
(signature
yr slut 1 y rumie- brare of 1'lorfda )
Personally Known _X OR Produced Identification
Type of Identification Produced
Com
My COMMISSION # FF9&663
I
Signature ontractor/License Holder
STATE OF FLOR
COUNTY OF
The forgoing instrument was acknowledged before me
this 31 day of 20 _a by
(Name of person acknowledging )
jr� n G
(Signature of Notary Publie- State of Florida }
Personally Known_ OR Produced Identification
Type of Identification Produced
REVIEWS I FRONT ZONING SUPERVISOR I PLANS
.__ COUNTER REVIEW REVIEW REVIEW
COMPLETE
INITIALS
63 (seal)
ANNe aRp ^"
Ny COMMISSIO
EXPIRE$ N # FF984663
AP10 21, 2020
VEGETATION SEA TURTLE 71AANGROVE
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