HomeMy WebLinkAboutBuilding Permit Application �!I I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ e �s-z Permit Number:1!I '018o
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Building Permit Application III
C Planning and Development Services i
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 j
Phone:(772)462-1553 Fax:(772)462-1578 Commercial I Residential a
!PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end d line
PROPOSED IMPROVEMENT LOCATION:
Addressi 167
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Legal Description:
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i Property Tax ID#: k0S-CJ GNU 5 —G G C� �] Lot No.
Site Plan Name: i Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: IJI
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DETAILED DESCRIPTION OF WORK: . . i !i
Remove Existing Pedestal Replace with new
CONSTRUCTION INFORMATION:
Additional work to 5213aff5rmed under this permit—c ec a11 apply" I i
E1HVAC Gas Tank ❑Gas Piping _Shutters j l Windows/Doors
Electric F1 Plumbing ❑Sprinklers Generator ':�Roof Roof pitch
Total Sq.Ft of Construction: SFt.of First Floor: i,
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Cost of Construction:$ t`o G U Utilities . Sewer L_I Septic j Building Height:
OWN ERAESSEE: CONTRACTOR: j
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Name Re-v-e,r-, a �..5�- P r'.-r _ _ Name:John R taw
/address: 1 U 7 cj S. k2111 I-P C-2 G 41 Company:Laves Electricai'!Service Inc.
Ci -7T7e&-v.S r t% t3 rel.-4 State: Address: 5158 NW Priimml,t
Zip Code: Fax: may: Pt ST Lucie Iii State:FL
Prone No. -),;k Zip Code: 34963 Fax:
E-Mail: Phone No-7723704367 Irl
Mill in feesimple,Title Holder on next page{if different E-Mail:lohnlaw5158Qaol!com
from the Owner listed above) State or County jicense:I'29432
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required'
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**FORM
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DESIMER/ENGIMEER: _PlotApplicable MORTGASECOMPANtr:, Not Applicable
Marne• Name:
Address: Address: i l
City` State' Crty: I i,i State:
Zip: Phone: Zip: I Phone:l
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FEE SIMPLE TITLE HOLDER: � Not Applicable BONDING COMPAft: Not Applicable
Name: Name.--I I';:
Address- Addis: I i
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Zip: Phone: Zip: i Phone:
t cerii'y that no work or irminflation has commenced prior to the Issuance of a permit (;i
I St.Lude Con makes no representation that's granting a it will authorsze'the etn�i lsai tc build the sul lectstrutture
which Is in conflict with a%applicable Home OwnersAssoa�o rules,bylaws or and aavenants may restrict or prohibit such
structure.Please consult w�h your Home Owners Association and review your deed for any readclions which may apply.
# In consideration of the granting of this requested permit;I do hereby agree that I wJIU,in all respects,perform tine work
In accordance with the appraved plans,the Rorlda Building Codes and St.Lucie CountyAmendments.
The foltc3wing building permit applicat ons are exempt from undergoing a full concurren�r review:room addlGf=%
accessory structures,sWa ing 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 recanted and posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with l6nder or an attorney before
commencing work or rec+ordin your Notice of Commencement 1 i.!; I
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-Siffn jre ownerf Lesseeffigent Signature of Goo 'tjLicense holder
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STATE DFASTATE OF FLO i 4
COUIM OF�� . LKL�!_
COUNWO °'k,I� .ae t
Theforgoing instrumentwas acknowledged before me The forgoing iristrumen�twos acimowledged before me
this r— day of F4.4 _, 20 LL-by thi`sS�day iaf ? 20-Z by
(Marne f person acknowledging) (Name erson adaiawledging)
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(Signature of Notary P5blic-5 Florida 1 (Sgnature cf Notary ,i b)lc State of Florida)
Personally Known OR Produced Identification Personally Known Pira OR Produced Identification
Type of Ident'sfication'produced Type of identification duced
Corea fission ' � Comrnission Na ,, {Scali
ANNE BROWN WALMAt'.F) I `
Revised ¢ exini;s Agsi'!2t,Z0 ' !=~-LIN► � wALMgCy
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l REVIEWS FRONT ZONING SUPERVISOR PLANSVEGE A,71ON I SEAT " �JIJNGRMIE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW . REVIEW
DATE -! I
COMPLETE
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