HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 -), Permit Number:
iCOUNT
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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 10 _%.Z S S CY 4 vt y9✓I- 11:i� 2 ,-V
Property Tax ID #: S- - U C' c ' Lot No.
Site Plan Name: Block No.
Project Name:
[DETAILED DESCRIPTION OF WORK:
YZcn/�cc 141 C
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_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: $ Gc� Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 7 c/_
Address: 213 y ~ �' C �-
Name: John Law
Company: Law's Electrical Service Inc.
City: 1/" r 'f State: f�/
Zip Code: 3 3 1 7 S Fax:
Address:5158 NW Pnmm St
City: Pt St Lucie State: FI
Phone No. 7 ,;L, -
Zip Code: 34983 Fax:
E-Mail:
Phone No 772 370 4357
Fill in fee simpleTitie Holder on next page (if different
E-MailSohnlaw5158@aol.com
from the Owner listed above)
State or County License EC 13006370 29432
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,S00 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:
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.
./' � Cam- �Y
r✓^ �` - — _
SignatuA of Owner/ Lessee/Contractor as Agent for Owner
Signature of ontractor/License Hoider
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 20�`?by
this _ day of 1 20� 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 01
gigiRstup
of Notary Public -State of Florida }
-t'"r►° RACHEL .
DAVIT
Commission No ; IC ' a MY COMMISSIO
;.InMpiS§jo
No,
EXPIRES Janu
Lry 5, 2019
RACHEL M DA
;
(407) 398-0153 FlondallotaryS
rvice.com
:. MY COMMISSION #FF1
IRES January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
I RG'dEe.c
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17