HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
;�COUNTY4
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 xxxx,10=
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: ' S _� /y r- /// i2l "I
Property Tax ID #: i`/ SU Z S—D / % / l 67 U0e) Lot No.
Site Plan Name: Block No.
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
Windows/Doors
Roof Pitch
Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name ri 0-- TO 4 iC 14,Tv -r n
Name: John Law _
Address: �'I 3 A, z: 411 r1 112! � ..1
Company: Law's Electrical Service Inc.
City: dc-1, �. State: _
Address:5158 NW Pnmm St
Zip Code: 7 Fax:
City: Pt St Lucie State: FI
Phone No. L/
Zip Code: 34983 Fax:
E-Mail:
Phone No 772 370 4357
Fill in fee simple Title Holder on next page (if different
E-Maiifohnlaw5158@aol.com
State or County License EC 13006370 29432
I
from the Owner listed above)
If value of construction Is $2500 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: Nacre:
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 prohlblt 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
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 I l:. day of ' : 1 - . 201�"1"1 by this / t. day of J L'I ) , 20_1�Lby
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public -State o
Commission No. a_
9 f`
(407) 398-0153
REVIEWS
DATE
RF_CFIVED
DATE
COMPLETED
Rev.8/2/17
FRONT I ZONING
COUNTER REVIEW
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
46:___�..__ of Notary Public- State of Florida )
RACHEL M '1DA!S.
MY COMMISSION f6pp _Sic No.
EXPIRES January 5, 2019
FloridallotaryS rvice.com
SUPERVISOR I PLANS VEGETATION
REVIEW REVIEW REVIEW
REVIEW
RACHEL M DA'
MY COMMISSION #FF71
S January 5,