HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % �C_ Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Building Permit Application
Commercial Residential xxx==
Address: _ �C%7.�5 0 C -,-4 v, lit klE
Property Tax ID tl: �/ S l I �—U 7 C,) z SyCJ 0 UU Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
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: $ Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 4 --r C, Name:John Law
Address: a Company:Law's Electrical Service Inc.
City: kY1 v ,-1 1- i-, , , I t .—, State: k' Address: 5158 NW Primm St
Zip Code: Fax: City: Pt St Lucie State: FI
Phone No. iZ .� `i S 3 `4 1 Zip Code: 34983 Fax:
E-Mail: Phone No 772 370 4357
Fill in fee simple Title Holder on next page ( if different E-MailSohniaw515B@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
Nape:
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 contlict 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
com encine work or recordine vour Notice of Commencement.
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Signatuh of Owner/ Lessee/Contractor as Agent for Owner
Signature of`irontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for oing instrument wa acknowledged before me
this day of 20 / ` %by
The forgoing instrument was acknowledged before me
this � day of �'� I 20—L-�J by
i
_
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known Z OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public -State o
of Notary Public -State of Florida )
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Commission No. r` c ��`_ `�
a'►`°• My COMMISSION
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No.
'FUFn? EXPIRES Janu
try 5, 2019.
�,: RACHEL M DA
(407) 998-0153 FloridallotaryS
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MY COMMISSION OFF1
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IRES January 5,
REVIEWS
FRONT
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SUPERVISOR
PLANS
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17