HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /L t�• v� -.ill // Permit Number. �1 It Q)r.
•
Building Permit Application
Planning and Develapmenrservices
Building and Code Regulatfon Division
2300 Virginia Avenue,Fort Pierce FL 34982 BY: .......................
Phone:(772)452-1553 Fax:Vn)4U-1578 Commercial Residential xxx�ovc
PERMIT APPLICATION FOR_ To Select from clropbox, dick arrow attte end of line
PROPOSED IMPROVEMENT LOCATION -
Address:_ L Z� Ale- le,! I -
Legal Description:
Property Tax ID#: — S� '- Lf - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back RightSide• LeftSde:
[ DETA�ILEDDESCRIPTION-OF WORK
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AiJaltional worktob Fo rm e d un d e rthis perm e. a.. . ap )r
EHVAC Gas Tank []Gas Piping _Shutters Windows/Doors
ZElectric 0 Plumbing F]Sprinklers ElGenerator C1 Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor.
Cost of Construction• `J
$--; Unifies:11 Sewer U Septic Building Height
OWNERAESSEE. CQNTRACTOR " -
Name Tai J'6 c.i �r � Name: John R law -
Address: C' 7Company- Law's Electrical Service kc
cityState:JD-4/ Address- 5156 NW Primm St
Zip Code: SSD 3 Fax: City_ PT ST Lucie State:FL
Phone No- / S I -7 ? Zip Code: 34983 Fax
E-Mail: Phone No. 7723704-357
Fill in fee simple Title Holder on next page(if different E-Mail:1ohnknv5158@aolcam
from the owner listed above) State or County license: 294:32
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is rqulred_
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
aty:
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 confiict 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 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 recordin our Notice of Commencement.
s
—Signature
Owner/Lessee/Agent Signature of Con ctor/License Holder
STATE OF FLOR A A)C19
STATE OF COUNTY OF (/
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of /14•�.- 20 CZby this qday of j4!2,L/ 20 i 7 by
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(Name f person acknowledging} (Name erson acknowledging)
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1/tf I &Ali,
(Signature of NotaryPublic-Stat of Florida) (Signature of Notary Public-State of Florida)
Personally Known K OR Produced Identification Personally Known�_OR Produced Identification
Type of Identification Produced Type of Identification Rroduced
Commission Commission No.- F—��6.� (Seal)
ANNE BROWN WALMACH
FWGRO
Revised EXPIRES APO 21,2020 MY COMM) N WA[.AfgCH
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIONSEA TU p" GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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