HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: �i J Permit Number:
-
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential VV
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line�.)i 1k
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: s 5�� -.�� (a - 00a)- 4ea- Lot No.
Site Plan Name: Block No.
Project!Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe pertormed under this permit-c ec a appy:
0HVAC Gas Tank [:]G as Piping _Shutters Q Windows/Doors
Electric ElPlumbing Sprinklers Generator g Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ f!�Dd. D Utilities:cn Sewer Septic Building Height:
OWNER/LESSEE: _CONTRACTOR:
Name Name: James W Law
Address: / Company_ Law's Electric, Inc.
City: �L�� , .� ���State: Address: 218 Beach Avenue
Zip Code: �34Z 94Z f Fax: C;ty; 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.
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Ji SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERJENGINEER: _ _Not Applicable MORTGAGE COMPANY: Not Applicable
name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE S;MPLE TITLE HOLDER: Nat Applicable BONDING COMPANY: /Not Applicable
Name_ Name:
Address: Address:
City: Cty:
ZIP: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the vuork and installation as indicated.
I certify that no work or installation has commenced priorto the issuance of a permit
St-Lude County makes no representation that is granting a permit will authorize the permit hoiderto build the subject structure
Lvhich 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 appiy_
In consideration of the granting of this requested permit,I do hereby agree that 1 will,in all respects,perform the work
in accordance oink)the approved plans,the Honda Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
zrcessory structures,swimming pools,fences,vralls,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
improvementsto 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 tender or an attorney before
cornmen6ng work or recording our Notice of Commencement.
5 ature YOtivnerJ Agent/Lessee ' nature of Contractor/License Hoiden
STATE OF FLORIDA , LUCIE . STATE OF FLORIDA
i COUNTY OFCOUNTY OF ST. LtJCIE
j Thefo oinginstrument as acimowledg-eedme Thefo oinginstrumentwas acknowledged before me
this day of 2a? :by phis. day o� � zfl„�Oby
j JAMES W LAW JAMES W [AW
(Name of person adkmvnlfedging) (Name of person a�lttt74kii�edging J
(Signatr� Notary Public-State of Florida) (SignatureNotary Public-State of Florida)
personally Known AV� OR Produced Identification Personally Known ✓ OR Produced Identification
Tyne of identffication Produced Type of Identification Proderaed
commission No_ 4KNOTARY
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DATE
RECEIVED
IIL
DATE
CC)MPI ETED
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