HomeMy WebLinkAbout290 permitAll APPLICABLE INFO JALIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % Permit Number:
�l J
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349ii2
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential moo0o xx
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: qo2 0 & G Y/ rt a/ v _/
Property Tax ID 11: -7 .S'U .2, - SU I " / I o (o - Uyc-, - _ ( 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 Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ A U U vJI
cr
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C I, el
Name: John Law
Address:�2 u A/a /,j 13 /v_1
City: ']�!lc, t t h a-r�1-, Li State: �Jr
Zip Code: 3V 9 S' 7 Fax:
Company:Law's Electrical Service Inc.
Address:5158 NW Primm St
City: Pt St Lucie State: FI
Phone No. 772- 3 SS1 - `1 ,1? 2.l-(
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail lohnlaw5158@-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:
MORTGAGE COMPANY: _ Not Applicable
Name:
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 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
rnmmpnrino wnrk nr rprnrrlina vnur Nnfirp of Commencement.
4.
Signatt of Owner/ Lessee/Contractor as Agent for Owner
Signature of 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 it- day of rr_ �_, 20.2-9 by
this day of Fob 20_W by
Name of person m king statement
Name of person king statement
iZOR
Personally Known T/FOR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o
Notary Public State of Florida
y " �_e` RACHEL
No.! F \`^. 1
a!r My COMMISSIO
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7�AVIOSCommission
Na -•1
�..EXPIRES
Janu
RACHEL M DA\'(aW)%i8-0153
Fiondallotary
My COMMISSION #FF1I
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S January 5,
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FRONT
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REVIEW
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DATE
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DATE
COMPLETED
Rev.8/2/17