HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:.
11111ft_._ RECEI`.'rD SEP 13 2017
0 -
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 ✓
PERMIT APPLICATION FOR: To Select from dropboX, click arrow at the end of line
-PROPOSED.IMPROVEMENT LOCATION:
Address: (J
.Legal Description:
Property Tax ID#: 120 2-- 002 0- 4"')e Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED,D.ESCRIPTION OF WORK:
CONSTRUCTION"INFORMATION: =
Additional work to be Derformed under tis permit—check all M
app y:
HVAC Gas Tank 0Gas Piping Shutters a Windows/Doors
_00ectric ❑Plumbing Sprinklers OiGenerator Roof Roof pitch
Total Sq.Ft of Construction: sof First Floor:
Cost of Construction:$ �C�C�� D� Utilities:Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name:c� Name: James W Law
Address: 741 Z Company: Law's Electric, Inc.
City: State-,,& Address: 218 Beach Avenue
Zip Code: e� �`S�/ 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:
DESIGNER/ENGINEER: s/ Not Applicable MORTGAGE COMPANY: ✓ Not Applicable
Name: Name:
Address: Address:
City: State: City State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: V 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 Count makes no representation that is granting a permit will authorize thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an 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 1 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 our Notice of Commencement.
SIgAture of Owner/Agent/Lessee ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNIVOF SAINT LUCIE COUNTY OF SAINT LUCIE. .
The forgoing instru. ,nt w s acknowledged before me The forgoing instru ent was a knowledged before me
this oay of 0M q, 20�2by thig day of __ 200—by
JAMES W LAW A JAMES W LAW
( e of person acknowledging)�d,— (NI:,person acknowledging)'
&A, t?, tiL"',
(Signature of Notary Public-State of Florida) ( ignature of Notary Public-State of Florida
Personally Known ✓ OR Produced Identification Personalty Known $� OR Produced Identification
Type of Identification Producecli Type of Identification Produced
-Commission No. Commission No._../�r/O �trv� (Seal)'
' �,#+`'°"''•`�i�;: ANNE BRO
NVM
_ WALMACH ""''•
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�;;,, 1 EXPIRES April 21,2020
Revised 07/15/201.4 woil s9e a3 '=?o; EXPIRES April F kaa7service.00m r•' 21.2020
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