HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Building Permit Application
Commercial Residential xxxxxxxx
Address: I
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Property Tax ID #:
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I ,3.�'-(o -U o cl Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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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
Total Sq. Ft of Construction:
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Cost of Construction: $ 460c)
11
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name r-,,,, s A i f-e-
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Name:John Law
Address: / 00 / ,i ,' , pti
Company: Law's Electrical Service Inc.
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City: 9 S S #
Zip Code: / S Fax:
Phone No.
State: A�7
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Address:5158 NW Primm St
City: Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail:
Fill in fee simpieTitle Holder on next page ( if different
from the Owner listed above)
E-Mailjohniaw5158@aol.com
State or County License EC 13006370 29432
If value of construction Is $2So0 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:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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
rnmmanrina wnrk nr rarnrrilna vnnr Nntirp of CnmmanrPment.
Signat of Owner/ Lessee/Contractor as Agent for Owner
Signature 0f 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�Vdayof 7ay. .202Cby
this 1dayof 30.1 .20Avby
Name of person moking statement
Name of person king statement
Personally Known V/ OR Produced Identification
Personally Known I OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o
of Notary Public State of Florida I
P ' RACHELN
DAVIS
Commission No. F \"'� I -»�
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EXPIRES JanUi
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REVIEWS
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REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17