HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ S2 // 0&2.� / 17 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34082
Phone: (772) 462-1553 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: 111.E �/ C_ -r1
Legal Description:
PropertyTaxID #_ VA , ( 1J � rc �,, , -A J-cLot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
remove existing pedestal install new
r-;uu1L1Ur1a1 wvrK to ne errormea unoer this permit -check all t= apply: 1.-
OHVAC Gas Tank []Gas Piping Shutters O Windows/Doors
RIElectric O Plumbing OSprinklers O Generator O Roof
Total Sq. Ft of Construction: S . Ft, of First]] Floor:
Cost of Construction: $ Utilities:12 Sewer I- __1 Septic Building Height:
OWN ERAESSEE:
CONTRACTOR:
Name r 8--w + yo
Address: _�- C1 L .
City=—!:J--C vj State:
Zip Code: _Ll 1-Y ,g yy Fax:
Phone No. CJ - - Z 3 _Z__
Name: John R Law
Company: Law's Electrical Service Inc
Address: 5958 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: john1aw5958@aol.com
State or County License: 29432
u value W Lunncl ULuorJ no ;pc7uu or more, a Ktt VKUt1J Notice OT LOmmencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
NGINEER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip= Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip= Phone:
Not Applicable
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
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.
ignature Owner/ Lessee/Agent Sictor/Licens�Holde�r�
gnature of Con
_ S
STATE OF FLORIDA) STATE OF FLO c
COUNTYOF COUNTY OF� l
The forgoing instrument was acknowledged before me
this day of _M 7 20? -7 by
N
of Notary'Public- Stat 0-t Florida )
Personally Known K OR Produced Identification
Type of Identification Produced
The forgoing instrument was acknowledged before me
this A -2- day of A4 20 by
(Name erson acknowledging)
(Signature of Notary Public- State of Florida )
Personally KnownOR Produced identification
Type of Identification rod uced
Commission .l2!'
r. Arvly BRv1NN wALMACH Commission No.
Revised d7."Pt rj14 EXPIRES April 21, 2020
REVIEWS
FRONT
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SUPERVISOR
PLANS
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REVIEW
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DATE
COMPLETE
INITIALS
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MY COMA41Ss N # A M'AC! j
EXPIRES Anw - 984663
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