HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETER FOR APPLICATION TO BE ACCEPTED M I 1
Date: l !� Permit Number:
Atom Budding Permit Application
Planning and Development Services �U ��
y
Bultding and Code Regulation Division PER11HTTIN.G
2300Virginia Avenue,Fort PierceFL34W2 St. Lucie c.,'oL!nty, Fl-
Phone:(m)462-1553 Fax:(772)462-1578 Commercial Residential MOM
PERMIT APP{KATION EOR: To Select from dropbox, click arrow at the end of line , 1
PIOPt15Ei3 IM.PREIVEN1tl 'fiLjC
Address: 97757 A 'i{3Ny�.J :.. .......:.....::. . . :.
� Ale,
Legal Description:
Property Tax ID It 47(SC1,�-- -fid 1- /U69 1 00 0 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks • Front Back: Right Side: Left Side:
D PT1 �C? R
F 1N ?
ET L 'ES
remove existing pedestal install new _
C(3NSTRUCTI0N
-IKFOR Y ATIOW,;
rirona wor e e rm un er is permit—Check a . . aPP Y: :+
0 HVAC Gas Tank [DGas Piping _Shutters Windows/Doors
1Electric U Plumbing ❑Sprinklers Generator Roof
Total Sq.Ft of Construction: So.Ft.of First Floor
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Cost of Construction:.$ 4,0-"o Utilities:0 Sewer 0 Septic Building Height
4V1arIVERJiESSEE :..::: :" : :. . . .. :.::CONTRACTOR
Name T.,4" 1-r vYr, Name: Jahn R Law
Address: 2?T 90L) c,A,j c. Company: Law's Electrical Service Inc
City: (rJss T.s f!�2 _ State:AV Address; 6158 IOW P'rimrn St
Zip Code: ! "7 9 Fax: City: Fr ST Lucie She:PL
Phone No, { ' G�6 - fro 15 Zip Code: 34983 Fax:
E-Mad• Phone No. 772 370 4357
Fill in fee simple Tide Holder an next page If different E-Mail:john1aw5158@aal-oorn
from the Owner listed above) State or County License: 29432
If value of construction ls$Z90t!or more,a RECORDED Notice of Commenc ement is required.
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I EM NTAL, -O�NSTRUCTtON tt�i5t.CJ�W:FNFORMIATION,
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: � Not Applicable BONDING COMPANY: Not Applicable
Name: Name.•
Address: Address_
city. City:
Zip: Phone: Tap• Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit
St Lucie County makees�no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with an applicable Home Owners Assoclatian rules,bylaws or andcovenantsthat may restrict or prohibit such
structure-Please consult with your Horne Owners Association and review your deed for any restrictions which may apply.
Inconsideration of the granting of this requested permit,l 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 followingbuitding permit applicadons are exemptfrom undergoing a fiall 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..
s
_5igmatureOwner/Lessee/Agent Signature of Con ctorlticense Holder
STATE OF FLORIDAI STATE OF FLOPADA
COUNTY OF y�CK•tP COUNTY OF1
The foreoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this.13'„day of n r, . 20 !—';by this day of -J +� 20 by
(Name f person acknowledging) (Name erson acknowledging)
On A� 1� /w/, a)kl Ix
(Signature of Notary Public-Stat o Florida) (Signature of Notary Public-State of Florida J
Personally Known _OR Produced Identification Personally Known t3R Produced identification
Type of Identification Produced Type of IdentificationLuced
9 �'�-• ,/
Commission .� Commission No., � (Seal)
ANNE,BROWN WALMACH ;•.;--•�
Revised •• ' EXPIRES April 21,2020 ' MY COMlytSS1 NACH
fk+gdelYaierygp pp�ry aei}" •• EXPIRES
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU4e`f' GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
�INTIALS
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