HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -///7
Permit Number:
4111111111111111111
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300Virginia Avenue, Fort Pierce FL .34982
Phone: (772) 462-1553 Fax: (772) 462--1578 Commercial Residential xw=
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED_ IMPROVEMENT LOCATION:
Address: %/ %� -r„! , / ./
Legal Description,
..
Property Tax ID #; ,�G .SR-C� G 21 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 [Lep f,cc LvA_Vc-r 14c., #e,,, 41 C_, Pel ems)
Ov L j t ./ ` ✓1� .� "t r rG'
CONSTRUCTION INFORMATION:
Additional wor o e�ej Orme un er this perm --check a appy:
HVAC LJ Gas Tank 06
as Piping Shutters ❑, Windows/Doors.
Z Electric ® Plumbing Sprinklers Generator O Roof
Total Sq. Ft of Construction: . Ft. of First Floor:
Cost of Construction: $''
Utilities: Sewer I ,ISeptic Building Height:
OWNERAESSEE: CONTRACTOR:
---------------
Name d (J Name: John R Lave
Address: fv s ` acv c. r'i i,,, ISi Company: Larne's Electrical Service Inc
City: �. State:Address: 5358 NW Primm St
Zip Code: t-/ 2 Fax: City. PT ST Lucie State: FL
Phone No. - 1 " Lt S 7_ - G S S 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 $2.500 ar more, a RECORDED Notice of Commencement Is required.
i
SUPPLEMENTAL, -
Name:
Address:
City:
1 -Ip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
ACTION LIEN LAVH- RMATiON.
Not Applicable M
ORTGAGE COMPANY: _ Not Applicable
ame:
Address:
State: city: state -
Zip. ____ Phone:
Not Applicable 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 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, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved pians, the Florida Building Codes and 5t. Lucie County Amendments.
The folfowing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessary 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.
Signature Qwner/ Lessee/Agent FSTATE
ture of Con ctor/License Holder 5
STATE OF FLOR A - OF FLOCOl1NTYOF 4 [ NTY OF�� !cam
The fo—ing instrument was acknowledged before me
this day of s`�- 4,q � 20 1] by
Of
Florida )
Personally Known K OR Produced Identification
Type of Identification Produced
r� ems.
Commission `� q /,,(, "-_.
BROWN WALMACH
Revised d7Z EXPIRES April 21. 2020
REVIEWS FRONT ZONING
COUNTER REVIEW
i?ATE
COMPLETE
INITIALS
SUPERVISOR
REVIEW
The foreoing instrument was acknowledged before me
this 'l day of 3 1 20 by
(Name arson acknowledging)
1�
(Signature of Notary Public State of Florida )
Personally Known V OR produced Identification
Type of Identification roduced
Commission No. 3
(Seal)
MY oo1,,hirssroNiv # FF MACH
(<nraor �PIRes 9W83
PLANS VEGETATION SLA `" GRO
� I N
REVIEW REVIEW REVfEW REVIEW