HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��O �% Permit Number:
iCOUNTY
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: /1/C-H/ ti tyi L,J
Property Tax ID #: S- lJ 2- SD I % ? 7 7 Ga U l Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_ Gas Piping
_ Sprinklers
_ Shutters
Generator
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Block No.
Windows/Doors
_ Roof Pitch
Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name S _4,,,, r-S
Name: John Law
Address: L /V
Company:Law's Electrical Service Inc.
City: L 1- c a s Stater
Address: 5158 NW Primm St
City: Pt St Lucie State: Fl
Zip Code: 1 SS 63 Fax:
Phone No. 2 _?J -
Zip Code: 34983 Fax: _
E-Mail:
Phone No 772 370 4357
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailSohnlaw5158@aol.com
State or County License EC 13006370 29432
IT value or construction Is 52500 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.
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 indicatel.
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; vour Notice of Commencement.
Signatuv, of Owner/ Lessee/Contractor as Agent for Owner
Signature �L 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 f !-. day of ! , i li 20_ by
this l i, 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 o
of Notary Public- State of Florida j
R ACHEL
Commission No. - f a
On.°Iv
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MY COMMISSIONlo
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:' � •: EXPIRES Janui
Lry 5, 2019
RACHEL M DA
(407)1398-0153 FlondalloraryS
roice.com
MY COMMISSION #FI=1
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REVIEWS
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SUPERVISOR
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17