HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:yI l ��1 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 )0 O xx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:'
Address: ] U _70 l O k2e-1 k 1
Legal Description:
Property Tax 1D #: y / ( [ y U U ;2_2_ 06)c-, % __ Lot No.
Site Plan Name: _ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION P WORK:
Remove Existing Pedestal Replace with new
Additional work to oe pertormea under tnis permit- cnecK all apply:
HVAC 0 Gas Tank Das Piping _ Shutters Q Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S of First Floor:
Cost of Construction: $ ;.� 0 Utilities:Ft. Sewer ❑Septic Building Height:
O W N ERAESSEE: `
CONTRACTOR:
Name &L, L't.- o,-- C
Address: % `( c) C . c' 1 /1- I /v
City: 6,1,: 4 r7.1 [ L,, State:
Zip Code: 3 7 Fax:
Phone No. (- S L[ - �[ % _ 7 [ L
Name: John R Law
Company: Law's Electrical Service Inc.
Address: 5158 NW Primm St
City: Pt ST Lucie State: FL
Zip Code: 34983 Fax:
Phone No. 772 3704357
E -Mail: johnlaw5158Qaol.com
E -Mail:
Fill in fee simple Title Holder on next page (if different
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: iNot Applicable
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 thepermit 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.
x7
Signaty of Owner/ Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
d
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF S f L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 7 day of OC � 120 t Y by I this 7 -7 day of C �_ / , 201S -by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known ' OR Produced Identification
Type of Identification Type of Identification
Produced Produced
. � _ � ofcNota L Public- S
(Signature of Notary Public State o Notary tate of Florida }
RACHEL DAVIS
Commission No. ' v ",—( =a
798-0153
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
MY COMMISSIO�PR�?3ioh No.
ry
EXPIRES Janu 5, 2019 `j
SUPERVISORPLANS I VEGETATION
REVIEW REVIEW REVIEW
RACHEL M DAI
MY COMMISSION #FF1
REVIEW I R
January 5, l2CIj9