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HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: "7 U / Permit Number: w Building Permit Application Planning and Development services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax:(772)462-3578 Commercial Residential Xoocxxx PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION. Address: 0 Legal Description: Property Tax ID#: r-,, Ozi� ---L- Lot No.. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF 'WORK: remove existing pedestal install new 150 amp meter combo pack on 2"alum strut stand CONSTRUCTION INFORMATION Additional wor to e e orme under this permit—Check a apply: OHVAC IlGasTank []Gas Piping Shutters Windows Doors ©Electric 0 Plumbing Sprinklers 0 Generator O Roof Total Sq.Ft of Construction: .Ft.of First Floor: Cost of Construction:$ !� UtilitiesSewer El Septic Building Height: ht: OWNER/LESSEE. CONTRACTOR. Name__6, r he Name: John R Law Address:_ 3 1 �y v r'✓i r<- YG f' — Company: Law's Electrical Service Inc City: State: Address: 5158 NW Primm St Zip Cade: jn &I Fax: City_ PT ST Lucie State-FL Phone No. .- �] .b Zip Code: 34983 Fax: E-Mail: Phone No. 772 370 4357 Fill in fee simple Title Holder on next page(if different E-Mail: johnlaw5158@aol.com from the Owner listed above) State or County License: 29432 if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL:CON5TRUICHON LIEN CAW.-INFORMA,TION: 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: _ Nat Applicable Name: Name: Address: Address: City: City:_ _— - Zip: Phone: 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 Nome 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:Y r failure to Record a Notice of Commencement may result in your paying twice for improvements to your pro erty,A Notice of Commencement must be recorded and posted on the jobsite before the first inspection.if you intend to obtain financing consult with{ender or an attorney before commencing work or reco d ing vour Notice of Commencement. s _signature Owner/Lessee/Aient Signature of Con etorJLicense Holier STATE OF FLORPAj STATE OF FLO j t COUNTY OF / COUNTY OF �� ,,( ucle- The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 4 i 2Q by this l day of a ,20 by (Na91 n UA� --6 me of person acknowledging) r (Name erson acknowledging) 7 (Signature of Notary Public Stat 'of Florida) (Signature of Notary Public-State of Florida) Personally Known K OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identificatiouced r<, Commission — —9 _ __ Commission No. (Seal) ; N ANNE BROWN WALMACH Revised EXPIRES April 21,2020 � '' My C�MI�I r9wuW�WaIMgCH FlorideNoterySerriee.eom a©7j "Pf�ES #F 883 Sao REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA � GROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS BUILDING & CODE REGULATION DIVISION 2300 VIRGINIA AVENUE i :N- _�°' FORT PIERCE, FL 34982 772-462-ISS3 FAX 772-462-1S78 AUTHORIZATION FORM FOR CREDIT CARD PAYMENT TO: St Lucie County RE: Permit # Credit Card Users: I.501b Surcharge added per transaction. Payments must be received in this department by 4:00 PM for transaction to be processed that day, if not it will be processed the following business day. ✓l VISA MASTERCARD Credit Card Number / Expiration Date /� Zip Code 3 digit security code e a(, Amount $_ , �c>_ca + 1.5% surcharge Business Name: . , Authorized Signature: Print Name: ZT0- L Phone: (-2-2--29 '7k9 7 Fax: Comments: SLCPDSD Revised 4/0 112 0 1 0 EN