HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dat e;. /� Permit Number:
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 I/' Residential
PERMIT APPLICATION FOR: To Select from dropboX, click arrow at the end'of line .
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax 1D#: '7 �r `r3 �� �" ��6 'e Lot No.
`"
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION'INFORMATION:
AdditionalworKtOpeperformed un er t is permit—check all that appy:
❑HVAC Gas Tank Gas Piping Shutters Windows/Doors
VElectric FlPlumbing U Sprinklers F]Generator FIRoof .Roof pitch
Total Sq.Ft of Construction: SQ.,Ft.of First Floor:
Cost of Construction:$ �. G`� C� Utilities:0 Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name I Name: dames W Law
Address: c+76& '54D Company: Law's Electric, Inc.
City: State Address: 218 Beach Avenue
Zip Code: q�!FS 3 Fax: City: Port St.Lucie State: FL
Phone No. Zip Code: 34952 Fax: 772-878-3347
E-Mail: Phone No. 772-971-4512
Fill in fee simple Title Holder on next page(if different E-Mail: lawselectricinc@aol.com
from the Owner listed above) State or County License: ER0000122
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERIENGINEER: Not Applicable MORTGAGE COMPANY: VNot Applicable
Name: Name:
Address-- Address:
City: state: city: State:
Zip: Phone: Zip: Phone:
SUPPLEMENTAL
EMENTAL C�
PPL
4F
_Rj N INEER
DF E G
-SIG!
Name-
BONDING COMPANY: Not Applicable
FEE simpui TITLE How _v_Not Applicable
Name: Name:
Address: Address-
City: City:
;5p: Phone: Zip:- Phone:
NERI CONTRACTOR AFFIDVIT:Application is hereby made to obtain 2 permlitto do the work and installation as indicated.
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 subjectstructure
which is in conflict with'anY applicable Home Owners Assocjatlon rules,bylaws or and covenants that may restrict or prohibit such
structure-Please consult with your Home Owners Associatibn and review your dead 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 penriii:applications are exemptfrom undergoing a full concurrency review:room additions,
-accessory structures,swimming pools,fences,walls,signs,screen roams 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,con It mfith lender or an attorney before
commencins work or recordi IgVour Notice of Commencement.
Sign re of flwnerJ Agent)Lessee Si Lure of Contractor/license Holder
-V
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF ST.LUCIE '. COUNTY 01�-- ST. LUCIE
The forgoing in merit was acknowledged-before me The forgoing in"ntwas acknowledged 4eforeme
f
f
this A�l day o
th-M,W day 20by 20-Z-17--by
7—
JAMES W LAW JAMES W LAW
(Name person a&-msa&adg7jng I (Name of person aftrib*Iedging I
/0
&L fi. ar, Z�
- {Signature--
(signature of-NotaPublic-StateNW Florida) c, of Notary Public-State of Florida)
Personally Known V`-` OR Produced Identification_ Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Prod pyLP;
' ' ANNE BROWN WAL
i�6%.7' . M3
0 MACH
IfNNE BROWN 4ALW ion wo; FF 984 KA sail
6 i
Commission No-_fF�g8-4663 SION#FF9W63
my COMOSSION#
663 EXPIRES April 21,2020
0 1
EXP 10en A-
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
QATE -
CogPLETED