HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t5,�- �'��f. e? Permit Number F �
Building Permit Application
Planning and DevelopmentServkcas JUN 21 2017
Building and Code Regulation Division
23W Virginia Avenue,Fort Plence FL 349982
Phone:(772)452-1553 Fax:(772)462-1579 Cominerdat Residential x+000a
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
R P D 1 PR UEMEM LOCiAM. -
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Address- 10,�,! N t W e-1 �a
Legal Description:
Property Tax ID#: a-' SU J— / 0 Gj G Biu- Z Lot No.
Site Plan Name: Block No-
Project Name-
Setbacks Front Back: Right Side: LeftSide:
.DETAILED DESr ,.014-
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remove existing pedestal install new
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+ono wo a rme er un +s pe — all appy:
HVAC Gas Tank' Gas Piping _Shutters a windows/Doors
✓Z Electric F-1 Plumbing []Sprinklers []Generator C Roof
Total Sq.Ft of Construction: Ft of First Floor.
Cost of Construction: GU tltiCities�Sewer Septic Building Height:
OWNER LESSEE:::.. .: ... .:; COIU ' CTOi; :`:•::.::;``::. .
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Name M r,--e jt G4 1 j rr j-e - Name: John R Law
Address:_J 3 G -5*,-e c*r, 14, 11 Yl,l Company: Lew's Electrical Service Ino
City: We—,l— C Gr er�-e,C,'c f j State: - Address: 5758 NW Prirnm St
Zip Cotte: 03 L(Iv 6 Fart City: PT ST Lucie State:PL
Phone No. /- gu, - 2, 9, Zip Code: 383 Fax:
E-Mail: Phone No..772 370 4357
Fill in fee simple Title Holder on next page(if different E-Mail:john1aw515Maol.com
from the Owner listed above) State or County license: 24432
lfv�us of construction is$2M or more,a RECORDED Notice of Commenceraentlis required.
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SI9PP fMENTa CQ:1 5Tl lCTIOIN:°C[EN:[A1fU-tN:EORi1�lATiON
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: Zip: Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit.
St Lucie County makes no representation that is granting apermR will authodzethe permit holder to build the subjectstructure
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,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 Jude County Amendments.
The following building permit applications are mcemptfrom undergoing a full concurrency review:room additions,
accessory structures,swim ming pools,fences,wails,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
commencin work or recortling your Notice of Commencement_
s
Signature Owner/Lessee/Agent Signature of Co ctor/License Holder
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STATE OF FL.OR A - STATE OF FLO D c
COUNTYOF . (IC�P COUNTYOF� une
Theforaoing instrument was acknowledged before me The forecing instrument was acknowledged before me
this 1 day of s n _ . 20 17 by this day of _5V W&e P 20 by
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(Name f person acknowledging) (Name ersonnacknowledging)4&M f� , &dkit. 1xia/c_�_
(Signature of Notary Publio-S o Florida) (Signature oF Notary Public-State of Florida)
Personally Known Y, OR Produced Identification Personally Known __ —OR Produced Identification
Type of Identification Produced Type of identification(Rroduced
Comrrirssion r Commission No. (� {Seal)
ANNE BROWN WALMACH
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Revised ? EXPIRES April 2i,2020 `j MY OoIbMISS►pN*ALIWAt/
Fronernose (toy....• brP1I2863
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TiiGROVE
COUNTER REVIEW REVIEW REVIEW, REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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