HomeMy WebLinkAbout2056 nettlesALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number_
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
xxXXXx
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ,, C S- J(--:, /VG 791 e?,
Legal Description:
Property Tax ID #: y S �' :� O i - (JG' c� - " Lot No. _
Site Plan Name: Block No. _
Project Name:
Setbacks Front Back Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
Additional work to ne erformea under tms perms- cne�R an apply.
1]HVAC [] Gas Tank ❑Gas Piping _ Shutters Windows/Doors
❑✓ Electric ElPlumbing Sprinklers Generator D Roof
Total Sq. Ft of Construction: S tewerOSeptic
f First Floor: _
Cast of Construction: $ / `� �/ u Ufil'fies:Building Height:
OWNERAESSEE: -
CONTRACTOR:
Name L,,, ✓ -r,, PA2�
Address: G S /L' e 'HI �s 1
City: Tr-1 ac,A-c-L, State:1 !
Zip Code: 2 `/ `t S-7 Fax:
Name: John R Law
Company: Law's Electncal Service Inc
Address: 5158 NW Nmm St
Cry: PT ST Lucie State: F1.
Phone No. 6, I ? -- 3 ,�' 7 -'7.S 7y
Zip Code: 34983 Fax:
E-Mail:
Phone No. 772 370 4357 —
Fill in fee simple Title Holder on next page ( if different
E-Mail: johniaw5158@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 requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name.
Address:
City; State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicatec.
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_�vork or recording your Notice of Commencement.
Signature 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 acknowledged before me
The forgoing instrument was acknowledged before me
this day of 7 ,_ c , 20 by
this "day of 20_LLi 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
(Signature of Notary Public- State o ,,
of Notary Public- State of Florida )
D v�iv
RA'1 HEL I
Commission No s' MY COMMiSS10t
i io
No. t V.
EXPIRES Janui
try 5, 2019
` rP`°`�_ RACHEL M DA"
(407) 399.0153 FloridallotarySt
rvice.com
MY COMMISSION #FF1 t�;... '�
IFiES January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17