HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: Permit Number:
Z--
PERMIT
Building Permit Applicatio
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST EPhone: (772)462-1553 Fax: (772)462-1578 Commercial ResiAPPLICATION FOR: Electrical a
PROPOSED IMPROVEMENT LOCATION:
Address: L14-4 t2p
Legal Description:
Property Tax ID#: O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona wor to e e orme under this permit–check a apply:
HVAC Gas Tank F_1 Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers F1 Generator a Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ �wC�w. l� Utilities:Cn Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: James W Law
Address: Company: Law's Electric, Inc.
State: FL Address: 218 Beach Avenue
City: —
Zip Code: 3__/Zk / 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: _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:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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. i€you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/Agent/Lessee Wnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST. LUCIE COUNTY OF ST. LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of r.: 20 _by thisv� 'day of �(L. 2G Lby
JAMES W LAW JAMES W LAW
(Name of person adknoidledging) (Name of person 6bka0*Iededging)
(Signatu a Notary Public-State of Florida) (Signaiufe o Notary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced identification
Type of Identification Produced Type of Identification Produaed
Commission No_GL'1'b4,E,? S� 1 Juliet Law Commission ivo. (Seal)
14
NOTARy pUBL14p ' Law
0 1 A I t OF FLORIDAW".__ C0Mrr*
ARY PUBLIC
Revised 07/15/2014 a Expires
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANIMLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED