HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 5
Date: Permit Number:
sI, - RECEIVED
Building Permit Application APR 2 7 2018
Planning and Development Services
Building and Code Regulation Division ST, Lucie County, Permitting
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
PROPOSED IMPROVEMENT LOCATION:
Address: .SG //C M1-, 61 tv.�
Legal Description:
Property Tax tD ii:_ LZ_S—C,�2 - SU l - U.,1-1-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
FDETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work toe Pe rMed under this permit-check all tbat apply:
0HVAC Gas Tank F]Gas Piping _Shutters L._1 Windows/Doors
RJElectric FlPlumbing Sprinklers []Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor.
Cost of Construction:$ �,,2 G��
Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name_13c.ltjYj- L ,f-f cc-,jo Name: John RLaw
Address:_ Co c) n; s a Company: Laws Electrical Service Inc.
City: C-.4 s State:_&/f Address: 5158 NW Primm St
Zip Code: v/ U z Fax: City: Pt ST Lucie State:FL
Phone No. l- Lq t 3 S S sfLivL2- 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.
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SUPPLEMEi 7AL CONSTRUCTION LEEN LAIN INFORMATION:
E DFSIG1VERfENG131ibER: - NotApplicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
L
City. State: City: State:
Zip: Phone: Zip: Phone:
f FEE SIMPLE TITLE HOLDER: Not App!icable BONDING COMPANY: iVotApp[icable
4 Name: IVam>r:
Address: Address
City_ City:
Zip: Ph one: Zip: Phone:
0NER/CONTRACTOR AFFIDVIT:Application is hereby madeto obtain a permitto do the work and installation as indicated-
ceythat no work or installation has commenced prior to the issuance of a permit.
SL Lucie Coun makes no representation that is granting a permit will authosize•lhe permit holder to build thesubjectsrructure
which is in co�ictwith any applicable Home Owners Assocration rules,bylaws or and covenants that may restrict or prohibit such
structure-Please consuit3i O your Nome OwnersA,ssociaUan and reviewyourdeed for any restrictions which may apply.,
In consideration ofthe granting of this requested permit,I do hereby agree that I will,in all respects,perform the work-
in accordance vWfth the approved plans,the Florida Building Codes and St.Lude County Amendments.
The following building permit applications are exemptfrom 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 fail ure 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
coMp2en n work or recordin • our Notice of Commencement
Signature a caner/AgentJ Lessee S:rgnatur Contractor/License Helder
STATE OF FLORIDASTATE OF FLORIDA
�-LUClE
COUNTY OF COUNTY OF ST- WCIE
The forgoing instrument was acknowledgectbefore me The forgoing instrument was acknowledged before me
this SQ_day of_mow. / _.20 LF_by this 9,�day of 20-Le-r by
(Name of person adlrnaF4edging) (Name of person abkt ledging) �-
1
(5gnature of PJotary I�ublic--state of Florida} (Signature of Notary Public-State of Florida}
iPersonally Known `✓ OR Produced Identification Personally Known -"� OR Produced Identification
Type of Identification Produced Type of Identification Proderaed
Commission-,io._FF 984663 *.•i; _( E BROWN WALr Lo
m'cssion Ivo. F 63 (Seal)
....... ANNE BROWN WALMACH
My COMMISSION A FF 63
a; EXPIRES April 21,2020 F984663
Revised OW15/2014 +�aTlaee oas� FbrWarratarys�ce,ao r « EXPIRES April 2t.2
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REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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