HomeMy WebLinkAboutBuilding Permit Application ALL APPLI SLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: . A owl? PermitNumber:11 r LJ
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Building Permit Application OCT 0 3 2W
Planning and Development Services PERMITTING
Building and Code Regulation DivisionFL
2300 Virginia Avenue,Fort Pierce FL 34982 . St. Lucie unty,
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line� CA L
PROPOSED IMPROVEMENT LOCATION
Address:
Legal Description:
Property Tax[D l€: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: e2 a
'
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
�IHVAC I]Gas Tank ❑Gas Piping a CGenerator
Shutters Windows/Doors
Electric El Plumbing Sprinklers Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor
Cost of Construction:$ [ I Utilities:0 Sewer El Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Name: James W Law
Address: O Company: Lanes Electric, Inc.
City:�P'��it State: Address: 218 Beach Avenue
Zip Code: Fax: City: Port St Lucie State: FL
Phone No. Zip Code: 34052 Fax: 772-878-3347
i
E-Mail: Phone No. 772-9714,512
Fill in fee simpiq Title Holder on next page(if different E-Mail: Iawselectricinc@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.
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UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ESIGNMIENGINEER: v/ NotAppligbie MORTGAGE COMPANY: ✓ Not Applicable
ame: Name:
ddress• Address: %"
ity: State: City: State:
p: Phone: Zip: Phone:
-SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
acne' Name:
ddress• Address:
lty: City:
ip: Phone: Tap: Phone:
I certify that no work or installation has commenced prior tothe Issuance cfa permit
Iucie County makes no representation that is grantinge permitwill authorize the permit holder to build the subjectstructure
cti is 1n conflict with any applicable Home OwnersAssoaation rules,bylaws or and covenants that may restrict or prohibitsuch
cture.Please nonsuit with youir Home Owners Asociation and review your deed for any restrictions which may apply.
onsideration of the granting of this requested permit I do hereby agreethat'I will,in all respects,perform tine work
ccordance with the approved plans,the Florida Building Codes and St.Lude County Amendments.
following building permit applications are exempt from undergoinga full concurrency review:room additions,
essory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
ARNING TO OWNER:Yourfailure to Record a Notice of Commencement may result in your paying twice for
mprovements to your property_A Notice of Commencement must be recorded and posted on the jobsite
efore the first inspection.if you intend to obtain financing,consult with lender or an attorney before
somme%ing work or recording your Notice of Commencement.
ig ture of Owned Agent/Lessee Mnature of Contractor/License Haider
STATE OF FLORIDA STATE OF FLORIDA
COUNTIF 01= SAINT LUCIE COUNTY OF SAINT LU.CIE
The forcing instrum nt was acknowledged before me Theforigoing instru entw s acknowledged before me
this~ i1ay of ry Q� z0 Eby th --slai►offi-c=;C��J��2Qf7;by
JAMES W LAVA JAMES W LAW
( e of person acknowledging) (N of person acknowledging)' Q
(Signature of Notary Public-State of Florida) ( gnature of Notary Public-State of Florida)
PeTsonally Known ✓ OR Produced Identification Personally Known OR Produced identification
Type of Identification ProducedType of Identification Produced
Commission No. FF-&eZ; Commission Afo.__� 1CTA1'(, - (Seal)•
P�� ANNE 8R0 .,,,
t�" Al
'• � EXPIRES AF►1121F B3 'S MY COMMISSION 0 FF9W4
Revised 07/IM/20I4 (4 ,7)9"183 n�ae•or ��?'4.�..•• EXPIRES I1pn72i.2o20
REVIEWS FROM' ZONING SUPERVISOR PLANS VEGECATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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