HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�`/ 1/ .2 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Building Permit Application
Commercial Residential xxxxxxxx
Address: l0 7 0 f S 0 C (J rt it�t 7
Property Tax ID #: ys// - S/ rJ - 0 O Ec� - O (' G — 7 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
{2 r/;�'lItt W t {-r� /' fr/%11s /" /
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:
riv
Cost of Construction: $ '2' U
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name vZdr.naGvyr".c-I.yn
Name: John Law
Address: /v lot S. Or-ntl 1,21L4-
1f 7
Company:Law's Electrical Service Inc.
City: S is - )I +4� �1
Zip Code: 3 `/ 5 S 7 Fax:
Phone No. l ' SO 7- fi t1 S- U%
Stater
G
Address: 5158 NW Primm St
City: Pt St Lucie State: F1
Zip Code: 34983 Fax:
Phone No 772 370 4357
E -M ailjot)nlaw5158@aol.com
E -Mail:
Fill In fee simple Title Holder on next page
from the Owner listed above)
1 If different
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
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Address:
EXPIRES Janu
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
REVIEW
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
commencingoork or recording your Notice of Commencement.
as Agent for Owner I Signature
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this 2,�(_ day of r_ti 4 . 203fiby
Name of person making statement
Personally Known ,e,L OR Produced Identification
Type of Identification
Produced
of Notary Public- State
V �
Commission Na. ! C \�-., i �-
,\
REVIEWS I FRONT
COUNTER
DATE
Rev. 8/2/17
796-0753
ZONING
REVIEW
STATE OF FLORIDA
COUNTY OF
Holder
The forgoing instrument was acknowledged before me
this 2i'J day of F -,-.A . 20,20by
Name of personaking statement
Personally Known OR Produced identification
Type of Identification
Produced
J, _
of Florida
'of Notary Public- St
RACHEL IY
DAVIS
MY COMMISSIO
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EXPIRES Janu
Lry 5, 2019
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SUPERVISOR
PLANS
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of Florida
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