HomeMy WebLinkAbout1274 nettlesAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
- J -1. 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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: % vZ "74-/ Ale Hl,-,- %S /v..1 --
Property Tax ID #: q S C';2- S-01- l'-1 �-' I - v U Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace Existinq Meter pedestal
CONSTRUCTION INFORMATION:
Block No.
Additional work to be performed under this permit - check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
lSoC' `�4
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name awioe- ie- rjejs,a,14-
Address:_ 11,4-1- you t S'.4t n - L ✓
City: S.4i,, i k+ - SL/ State: _
Zip Code: C. S Z Wy (o Fax: r ¢
Phone No. -S 1 `1 " ��b S�-I
E -Mail:
Name: John Law
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-Mailjohnlaw5158@aol.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License EC 13006370 29432
If value of construction is $2500 or more, a KtLUKUtU NoTice or ommencemem a reyuueu.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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:
MY COMMISSIO
Address:
City:
RACHEL M DA'
City:
Zip: Phone:
Zip: Phone:
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worK and 1T15tdlldl1U11 dS MUIL6LE J.
I certifv 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.
SignatuA 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 oft4 120 19 by this `1 day of i'l 7`;:� 20_Lfi by
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
DATE
COMPLET
Rev. 8/2/17
(Signature of Notary Public -State o^
et++eesof
Notary Public- State of Florida
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Commission No.
MY COMMISSIO
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RACHEL M DA'
EXPIRES January5
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(407) 398.0153 FlondallotaryS
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ExRES January 5,
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REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
DATE
COMPLET
Rev. 8/2/17