HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % �� �' Permit Number:
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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 xxxxxxxxx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 11 ( S A": HI f -Q `-
Legal Description:
Property Tax ID #: L C' 1 13 S (-' (_ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side:
CONSTRUCTION INFORMATION:
Additional wor to fi
ormed under this permit — check a
HVAC Gas Tank F]Gas Piping
Electric ❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Left Side:
LJ Shutters
❑ Generator
SFt. of First Floor: _
Utilities: Sewer aseptic
Block No.
❑ Windows/Doors
Roof Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ► 5 �j v•- j� :�%i�-
Name: John R Law
Address: 11 ( .3 'IL, HI, i !J '� -"/
Company: Law's Electrical Service Inc.
City: s z"� 15 �' •� State: (
Zip Code: 3 L1 ,!rJ S\ _) Fax:
Phone No. '7 7 ), _ z 3 2 6'=" 1 `'
Address: 5158 NW Primm St
City: Pt ST Lucie State: FL
Zip Code: 34983 Fax:
Phone No. 772 370 4357
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: johnlaw5158@aol.com
State or County License: 29432
If value of construction is $2500 or more, a RECORDED Notice or Lommencemem: is requireu.
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:
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
:ommen cin OFK Or reCOf U H 19 YUUf IVULILt. UI %_U1 I n I M1 I L ul 1 ICI 11.
Signaty,t`e 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 � day of /) f_ , 20 / � by this S day of G', c , 20� by
Name of person moking statement
Personally Known OR Produced Identification
Type of Identification
Produced
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
a
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(Signature of Notary Public- State o
RACHEL NI DAVIS
Commission No. '4 \ i _a€ MY COMMISSION
396-0153
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
EXPIRES January 5, 2019
Notary Public- State of Florida )
No. a s
SUPERVISOR I PLANS VEGETATION
REVIEW I REVIEW I REVIEW
REVIEW I REVIEW
RACHEL M DA
1111
MY COMMISSION #FF1
7
1
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9
January 5,
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REVIEW I REVIEW