HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %I �11 %I `!
Permit Number:
• ' 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'0°Of
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: (2 9 d X C N/r4 i I -/
Property Tax ID p: L/SC u- 5-U I - 0,, _7S G O 3 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:
—Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof Pitch
Cost of Construction: $ / S U ci Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name G A S h � S z r J? c Fru c.n
Address: S`Z P 1" 6, ..a ia., o d e YZ Z
City: Nr" I' 4S f/. State: f—t
Zip Code: / t� I W 1 Fax:
Phone No. �2' 2 C-1 - vt `1 3 G
Name:John Law
Company:Law's Electrical Service Inc.
Address:5158 NW Primm St
City: Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Maiijohnlaw5158@aol.com
E-Mail:
Fill in fee simple Title Holder on next page ( If different
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 requireu.
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 permitto 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 an applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult wylth 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
f C ment
commencin ork or recordingour Notice o ommence
[Sgnat
9
o-
Signature of ontractor/License Holder
of Owner/ Lessee/Contractor as Agent for Owner
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 L day of Al-' • 2011 by
this J_�__ day of N� 20 1' by
Name of person making statement
Personally Known OR Produced Identification
Name of person making statement
Personally Known OR Produced Identification
_
T%
Type of Identification
Type of Identification
Produced
Produced
f Notary Public- State of Florida }
State
(Signature of Notary Public o
RACHEL
DAVIS
-
Commission No. _4 it MY COMMISSIO
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P"ff*31
No. - r..r, ....
F `: RACHEL M DA
?,d'' EXPIRES Janu
ry 5, 2019
•
'1 MY COMMISSION #FF1
(40713N-0153 Foridallotary
mice.com
'a` January 5,
REVIEWS FRONT ZONING SUPERVISOR
PLANS
REVIEW
VEGETATION F IMOMBOVE0.
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17