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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 1u- r 7 Permit Number:
Las.1 g I W i M
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) 462-1578 Commercial Residential xxxxxx
PERMIT APPLICATION FOR:
To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �' 0 e- eq
Legal Description:
I PropertyTax ID #-
Site Plan Name:
Project Name:
Setbacks Front
/--/ s-/ 1- -S-() r - C,, 0 1-1 - a C, <', -�-
Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK
remove existing pedestal install new 150 amp meter combo pack on 2" alum strut stand
CONSTRUCTION INFORMATION:
Aciditionai work to be Dertormeci under this permit — check ailapply:
0nn
HVAC Gas Tank []Gas Piping M Shutters Windows/Doors
RiElectric ❑ Plumbing O Sprinklers CGenerator Roof
Total Sq. Ft of Construction:
Ft. of First Floor:
Cast of Construction:/7 0 U Utilities: U Sewer QSeptic Building Height:
OWNER/LESSEE; CONTRACTOR.
Names c v`�• ✓ c. m v►h Name: John R Law
Address: 1 2 7 A/ 13,4.c1 /v" S j- Company: Law's Electrical Service Inc
City: %f.State: (> Address: 5158 NW Primm St
Zip Code: _-�`r �fv �1/�3Fax: City_ PT ST Lucie
Phone No. z ��j �•, 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 $251Dp or more, a RECORDED Notice of Commencement is required.
State: FL
-UPPLEMENTAL.CONSTRUCT(ON LIEN LA-lN tNFORMATi0N
DESIGNER/ENGINEER:
_ Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
State: City: State: T
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
— Not Applicable BONDING COMPANY: Not 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 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. 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 your Notice of Commencement.
Signature Owner/ Lessee/Agent
STATE OF FLOT�.
COUNTY OFOC
The forgoing instrument was acknowledged before me
this)edayof y-7 . 20 by
/R/
person acknowledging)
(Slgnature of Notary Public- Stag o`f Florida)
Personally Known )C OR Produced Identification
Type of Identification Produced
r`
Commission eta �• rCaa!]
' ANNE BROWN WALMACH
,.,
' EXPIRES April 21, 2020
Revised Q,�z ' 44 �„ftN�ryS" �
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
COMPLETE
INITIALS
�
Signature of Con ctor/L�icense Ho der
STATE OF PLOD
COUNTY OF �
The forgoing instrument was acknowledged before me
this 4 F day of 20 by
(Name ! erson acknowledging)
4
� /1r� Al f d" (! i k
(Signature of Notary Public -State of Florida)
Personally Known OR Produced Identification
Type of Identification roduced
Commission No. /��,�� (Seal)
"INVWN WAL GH
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PLANS VEGETATION SEAfI (uc mGROVE
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