HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 IvZ `t1' 03 d�1
f � Permit Number:
6u1:PivaJad 'A4unOD apn-1 -1S
•
Building Permit Applicati ,n 81C] 6 9 M
Planning and Development Services
Building and Code Regulation Division L__ CDAIK)D d
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 7E.1 e
PROPOSED IMPROVEMENT LOCATION:
Address: Sc3 1 fes« 1911
Legal Description:
Property Tax ID#: 3 CJ 2 - E U 3 - CU( 7 - %jUG I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
necc: .2 � S r���c. n e-s. c.- (13e
11<r 141 C on
'1F0 . f'i Ov SSI Jo W4('04 IJ/Sl C�J�'VG
[CONSTRUCTION INFORMATION:
Additional work to ff
orme un er t is permit-c ec a app y:
HVAC Gas Tank Gas Piping _Shutters a Windows/Doors
ZElectric ❑ Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Constructio 5 Ft.of First Floor:
Cost of Construction:$ 7 G U Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name f►v-,u•F/ J.- C, i r c Name: John R Law
Address: 9 / G e -c- Company: Law's Electrical Service Inc_
City: r1 10i` 4 v< < State: (=/ Address: 5158 NW Primm St
Zip Code: '-t cl fit Fax: City: Pt ST Lucie State:FL
Phone No. A ys-- CJS 9 j Zip Code: 34983 Fax:
E-Mail: Phone No. 772 370 4357
Fill in fee simple Title Holder on next page(if different E-Mail:johnlaw5l58@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.
i
j SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: VNot 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 permitto 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 pen-nit 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.
c�
Signature of Oviner/Agent/Lessee Signaturef 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
thiso�1i day of 20,IX by this `'/ day of �',s %- 20-L'F-_by
(Name of person adknaWiedging) (Name of person aekrmMedging)
(Signature Of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known V' OR Produced Identification Personally Known '✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No_ FIF 984663 ;+:,'•, ( E BROWN WALM mission Ivo. F 3 (Sea!)
-- ;
ANNE BROWN WALMACH
:r
MY COMMISSION 0 FF 63
o, EXPIRES April 21,2020 [(40
F984663Revised 07115/2014 (407)398-0t53 FbrldaNaarySevrcecom 0EXPIRES April 2l,2020)398-0153 F, "N_,yS_w
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED