HomeMy WebLinkAbout281 holiday outAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �Xl/ /Z J 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 xxxxxxxx
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: /L' 7 J S- c ,.z Fyyl 1-t -'2—SI
Property Tax ID #:
Site Plan Name:
Project Name:
I DETAILED DESCRIPTION OF WORK:
-fir'11-1l/r-1 /SU 4--Y+e IMt��— ('c fir- �.1 6
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Lot No.
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ v2 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name rL � f� N, 11 cc F F
Name: John Law
Address: / C' 7.11 S` S• C)c +.I V) r - 4 .� � 1^
City: l_2 or, 9e- 4, State:Ly
Zip Code: (-I VS' 7 Fax:
Phone No. 70` - 7e-)& 7
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-Mailiohnlaw5158@aol.com
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License EC 13006370 29432
IT value or construction is >zsuu or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
commencing.Work or recording our Notice of Commencement.
--
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of, ontractor/License Holder
,r
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this �_ day of 20by
this J day of *r l , 20_ by
Name of person making statement
Name of person making statement
y
Personally KnownOR Produced Identification
Personally Known ' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
w
z
( : i F` y . i'.-{�L-.
_
.':.'� 14✓.f .'j �k �'c y'_
(Signatu ofNotary Public -State o
of Notary Public -State of Florida )
'
'P RACHEL RACHEL
DAVIS
Commission No. V-
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No. v, r,
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�.n EXPIRES Janui
Lry 5, 2019
'° RACHEL M DAVE
(407) 999-0153 FloridallotarySq
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MY COMMISSION #FF7 57
•••..,) 'oIR S January 5, 20
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
I 8QVEe.c m
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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