HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` !�
Date: 0, 7�1 7 Permit Number:
• y , �.
Building Permit Application
Planning and Development Services o E c 2 8
2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 rV.
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Res ideddif xxxxxxxxx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: i0 ,201 < <: [ r ✓C k�P�
Legal Description:
Property Tax ID#: L/S 0 & 61 - yCiCi - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove Existing Pedestal Replace with new
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a apply:
HVAC E]Gas Tank RGas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing O Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
el
Cost of Construction: $ �L G cJ Utilities: Sewer F-]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name '17,1 vi S.e t c ��_ Name: John R Law
Address: /11 -9-0cl !0/1- Company: Law's Electrical Service Inc.
City: State: Ff Address: 5158 NW Primm St
Zip Code:
-7 311 7 Fax: City: Pt ST Lucie State:FL
Phone No. 3Q S— 2 3 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$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL-CONSTRUCTION LIEN LAW:.01FORMA?ION.
DESIGNER/ENGINEER: _Not ApplicableMORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _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 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 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
s
_Signature Owner/Lessee/Agent Signature of Con ctor/License Holder
i
STATE OF FLOR A� STATE OF FLOI ` J U /
COUNTY OF . .r lC lP COUNTY OF �(
The forcing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of � �� 20 by this day of_ ,1i ke— 20 by
(Name of person acknowledging) (iNarne erson acknowledging)
n)U1 'IlLi
/� LZ — X
(Signature of Notary Public-Sta&of Florida) (Signature of Notary Public-State of Florida)
Personally Known X, OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification roduced
cam,
Commission Commission No. (Seal)
ANNE BROWN WALMACH '
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Revised 4 EXPIRES Apri121,2020MY COMMr ION a=Fg H
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EXPiIZES 63
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU o GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS