HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: // Permit Number:
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• Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X0000° x
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: / U -) U ) S GC eA h 12 Y_ 2 L' !
Property Tax ID i1: 4/S 1 / So I - G I `I % CUu 62 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:
Block No.
_Mechanical
_ Gas Tank
_ Gas Piping
_ Shutters
_, Windows/Doors
Electric
_ Plumbing
_ Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name I<r,� R c r. Cl"' K i,'l t /3 :..
Address: / yr 4 1(?,- . e f
City: CL•. State: �G
Zip Code:.2,')'-/ S 7 Fax:
Name: John Law
company: Laws Electrical Service Inc.
Address:5158 NW Pdmm St
City: Pt St Lucie State: FI
Phone No. A.2 11 2!t !u
Zip Code: 34983 Fax:
E-Mail:
Phone No 772 370 4357
Fill In fee simple Title Holder on next page I if different
E-Mailjohnlaw5158@aol.com
State or County License EC 13006370 29432
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work ano €nsta€€atlon as Ino€wtea.
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 ppermit will authorize the permit holder to build the subject structure
which is In conflict with any applicable Home Owners Assocation 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
commencina work or recordino vour Notice of Commencement.
44���
Signat of Owner/ Lessee/Contractor as Agent for Owner
Signature of ontractar/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
11 day of P � 201J by
this II day of A/,; . 20L by
this .
Name of person making statement
Name of person making statement
Known OR Produced Identification
Personally Known �� OR Produced Identification
Personally _z/
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public -State o
bf Notary Public -State of Florida)
RACHEL N
DAVIS
_
Commission No.:} F
a MY COMMISSIO
*31
No.
HEL M DA
EXPIRES Janu
ry 5, 2079
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pW€39-0157 Rondallotary
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January 5,
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ZONING
SUPERVISOR
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OWEe.
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17