HomeMy WebLinkAbout256 holiday outAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7��z f I `, Permit Number:
S � J
i;COUNTY
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Building Permit Application
Commercial Residential xxxxxax
Address: > U 7-2 _S_ _� . L ( r )- v, 12 ✓Z 4 14W �ZS
Property Tax ID #: y S/ l SU l C, l [ O c S 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 _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _ Sewer ^ Septic Building Height:
Pitch
OWNER/LESSEE:
I CONTRACTOR:
Name 5.4&1 c4✓t YYi f
Name: John Law
Address: Po
Company: Law's Electrical Service Inc.
City: hf-2 (? s f i,1,. v 4- State:,L4-
Address:5158 NW Primm St
Zip Code: S S (o.5 Fax:
City: Pt St Lucie State: FI
Phone No. S l S'' % L' `'I 7 `J
Zip Code: 34983 Fax:
E-Mail:
Phone No 772 370 4357
fill In fee simple Title Holder on next page (if different
E-Ma100hnlaw5158@aot.c0m
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 $7,500 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 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 aspects, 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
commencingyork 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 for Ding instrument wa acknowledged before me
this, day of 20 ! `lby
The forgoing instrument was acknowledged before me
this day of ��'�T_, 201`! 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 }
RACiHEL ,
D.- 5
Commission No. - _€ MY COMMISSION
4;PM j§§jo
No. YP�,
'•, °'
EXPIRES Janu
ry 5, 2019
:� 4°, RACHEL M DA
(407) 398-0153 FiondallotarySe
rvice.com
MY COMMISSION #FF1
ovr�,,.•'
R S January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
) q1MF
'I RQUE-1 c
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17