HomeMy WebLinkAboutbuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �}
Date: Permit Number-
Jill
umber:J _ - ,
Building Permit Application artn`e�
Planning and Development Servicespermt. e c k)nty
Building and Code Regulation Division St.��
1300 Virginia Avenue,Fort Pierce FL 34981
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential )00000000(
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: _�_S 1-1 LVC �� v
Legal Description:
Property Tax ID#: `� S(J� — Sci i Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: RI&Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove Existing Pedestal Replace with new
CONSTRUCTION INFORMATION:
trona worko e orme under this permit—check a appy:
0HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
ElElectric 0 Plumbing Sprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1606) Utilities:F Sewer OSeptic Building Height:
OWNER/LESSEE:'' CONTRACTOR:
Name RiAC, j-` C Name: John RLaw
Address: 6- S a y S`v C l A S 4 t Company: LaWs Electrical Service Inc.
City:,�f7..,J /2,,i n , State: A Address: 5158 NW Primm St
Zip Code: y9sli S ?fr3.4ax: City: Pt ST Lucie State:FL
Phone No. �2C.2 - Z G] Zip Code: 34983 Fax:
E-Mail: Phone No_ 772 370 4357
Fill in fee simple Title Holder on next page(If different E-Mail: lohnlaw5158Qaol.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.
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. If you intend to obtain financing, consult with lender or an attorney before
commencin ork or recording our Notice of Commencement.
Signat of Owner/Lessee/Contractor as Agent for Owner Signature of ontractor/license Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ),(-)day of 20 by this ",C day of �,�, 20S6y
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally KnownOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State o of Notary Public-State of Florida )
RACHEL & DAVIS
Commission No. 4,a € MY COMMiSSiOt�?t31 No. '. r '
EXPIRES Janu ry 5, lois :°`�r��' RACHEL M DAIFII
(407)JWP-0153 FlondaNataryso rvice.com MY COMMISSION#FF1 7
a... EX IRESJanuary5, 9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION I QVEe.cl m
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17