HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ ry
•
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°00O0O0C
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: [> S `7 /Gl r &,' s /3 / L" r
Legal Description:
Property Tax ID #: `iS v — �U 1 — L> k �/ �' C' �' Lot No. .
Site Plan Name: Block No..
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIPTION OF WORK:
Remove Existing Pedestal Replace with new
CONSTRUCTION' INFORMATION
Additional work toe e Orme under this permit —check a appy:
HVAC E. Gas Tank Das Piping _ Shutters Q Windows/Doors
aElectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ / S i✓� J ✓
S Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
OWNER/LESSEE:'
CONTRACTOR:
Name .) 4" e �& -f v e
Name: John R Law
Address: 1 % c9 (- i �'e S %
Company: Law's Electrical Service Inc_
Address: 5158 NW Primm St
City: '� .!J 4- '4 r•- State: i�'!
Zip Code: S Y 7.0 Fax:
Phone No. I --7u 1- 72 U V y2 Y
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
City: Pt ST Lucie State: FL
Zip Code: 34983 Fax:
Phone No. 772 3704357
E -Mail: john1aw5158Qaol.com
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: Not Applicable
Name:
Address:
City:
Address:
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
commencing work or recording your Notice of Commencement.
Signatuire of Owner/ Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L5 day of N o V20 I by this _L day of A/0v 20_�iy
Name of person making statement
Personally Known "' OR Produced Identification
Type of Identification
Produced_
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
a)
RACHEL NI DAVII
MY COMMISSION #FF1 7 1
EX�IRES January 5, 9
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(Signature of Notary Public- State o
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RACHEL
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DATE
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DATE
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Rev. 8/2/17
a)
RACHEL NI DAVII
MY COMMISSION #FF1 7 1
EX�IRES January 5, 9
REVI