HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I,2 / J Z f Permit Number:
r
•
Building PP 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
Legal Description:
Property Tax ID #: `ilS / %C> > - L� /� C%L,c ' 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION:
Additional work toe nerformed under this permit —check all appy:
HVAC Gas Tank []Gas Piping _ Shutters ❑ Windows/Doors
EElectric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: _
Utilities: 0Sewer 0Septic
Building Height:
OWNE�IRAESSEEI:
CONTRACTOR:
Name Y-� �( r�,' ) i SSI (
Name: John RLaw
Address: `-/ G— l c e f /%!Z
City: U .t v �, a �. t - S� f i, `14 n . ,$tate: L
Zip Code: r `f 5 6 11 3 Fax: 0 4 4.7 ,-+,,.fes
Phone No.
Company: Law's Electrical Service Inc.
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
It value of construction is �Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: e Not Applicable
Name:
Address:
Address: _
City: State:
Zip: Phone
City: State:
Zip: Phone: _
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name: _
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 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. _
I
Signat4kof Owner/ Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATEOF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before meI The forgoing instrument was acknowledged before me
this/
,97 day of 0c_ , 20 / � by this/.g day of /V r c , 20 / 9- 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
LA
(Signaturf Notary Public- State o bf Notary Public- State of Florida )
RACHEL IV DAVIS
Commission No. ' :3:: a!►= My COMMISSIO �IpF@M�3{o i No. 4 > gip.,,• (sea!
•,` a.< '�°' -;
-••.,?��d4• EXPIRES Janu try 5, 2019 RACHEL M DA'
My COMMISSION #FF1
(407) 398-0153 FlondallotaryS rvice.com
ori�,,,.�IR January!:),
REVIEWS FRONT ZONING SUPERVISOR PLANSVEGETATION ) 14vk3WPbCO$QkCEE1.c
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED
Rev. 8/2/17