HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
%1 (J Permit Number:
ti -
• Building Permit Application
Planning and Development Services
Building and Lode Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax; (772) 462-1578
PERMIT TYPE,
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential xxxxp
Address: Li
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Pou (
Property Tax ID #:
C) I — I (' G oV I
UUcl�
S Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical
XElectric
_ Gas Tank
— Plumbing
_ Gas Piping
Sprinklers
_ Shutters
_ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: —
Cost of Construction: $ S-C Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name N N n.t & a V. ( crr.n4 cc, n
Name: John Law
Company:Law's Electrical Service Inc.
Address: $'pv 0 S L S ( SvT7,
city: P I- S } C, v �, "cj State:
Zip Code: 3 `(5 7 Fax:
Phone No. 7k' SS 13
E-Mail:
Address:5158 NW Primm St
City; Pt St Lucie State; FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail lohn1aw5158@aol.Com
State or County License EC 13006370 29432
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is requirea.
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 and installation as Inuicaiea.
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
nrl . nr rnrnr Cii vnnr NntirP of rnmmPnrPmPnt_
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Signat 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 � day of Fc.4 20 J by
this J Y day of r-b , 203o by
.
Name of person making statement
Name of person IT king statement
Personally Known . OR Produced Identification
Personally Known I OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o
n Notary Public State of Florida
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January 5,
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SUPERVISOR
PLANS
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REVIEW
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DATE
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DATE
COMPLETED
Rev.8/2/17