HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services FEB 0 � `019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST, L��9I(? a�t1Cy, Pcrmlfiting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x*0000m
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED fMPROVEMENT LOCATION „ti i.„ t` '>
Address: /G 70 1 v v 4-k GGQ-",, YJyL Alt
Legal Description:
Property Tax ID#: LIS 1/ (,?(7 JG Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK '` t y
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CONSTRUCTION INFORMATION _
Additional work wor to ea orme under this permit-checkaapply:
❑HVAC M Gas Tank [:]Gas Piping Shutters ❑Windows/Doors
P1Electric El Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
u�
Cost of Construction:$ �'l C>U Utilities: . Sewer 0Septic Building Height:
OWNER/LESSEE m TRACTOR:`
CON
Name t h-e-,Al , 2 Name: John R Law
Address: f U'7 d 1 S • OC 0 44, 12rZ 9� Company: Law's Electrical Service Inc.
City: !e"Se�-+ c-,IC_J, State: Address: 5158 NW Primm St
Zip Code: 3 `i 1.87 Fax: City: Pt ST Lucie State:FL
Phone No. % 7 q LJ ;Y Zip Code: 34983 Fax:
E-Mail: Phone No. 772 370 4357
Fill in fee simple Title Holder on next page(if different E-Mail:johnlaw5158@aol.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`CONSTRUCTIQ'N LIEN LAW INFQRMATIOIVrr� {�
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 a 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 acknowledgeq before me The forgoing instrument was acknowledged before me
this_�t_day of .(–:,S .26 L.!$y this__�t day of F, 20_12 by
Name of person m king statement Name of person king statement
Personally Known AOR Produced Identification Personally Known—�OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State o of Notary Public-State of Florida)
OtiFy1YDpB�,s RACHEL IN DAVIS
Commission No.1�V\ –{?"5\ €�< a} MY COMMISSIO fIRfI§§iO No. -Z .
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a'. RACHEL M DA IcF'.' EXPIRES Janu ry 5,2019OF M1p(407)398-0153 Floridallotaryrvice.com '« MY COMMISSION#FF1 7 1
IRES January 5, 9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION1 Ee.c m
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17