HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 314 a () Permit Number:
Planning and Development Services
Building and Code Regulotion Division
2300 Virginia Avenue, Fort Pierce A 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Building Permit Application
Commercial Residential )1 °
I PROPOSED IMPROVEMENT LOCATION: I
Address: S CJ l /V a r// /1 1
Property Tax ID #: 41 So Z - SO l - G Ca S 7 000 - o Lot No.
Site Plan Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $
Windows/Doors
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name N�Hf•j (L
Name: John Law
Company: Law's Electrical Service Inc.
Address: 6177 5.4� /-� , Gv t
City: 1,Ve I f V-V. State: 0#
Zip Code: 0 b! Fax:
Phone No. l - 77.2- - 2A f? - 13G U
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
Address:5158 NW Primm St
City: Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail)ohn1aw5158@aol.com
State or County License EC 13006370 29432
If value of construction Is $2500 or more, a RECORDEu Notice at Commencemem is requircu.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
City:
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 molcateo.
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
rl' n nrrlino vni it Mnfira of r nmmanrPmpnt
i
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 I— day of #"A.� h . 20_2_vby
this _2_ day of 20 Z-by
Name of person mpking statement
Name of person king statement
Personally Known OR Produced Identification
Personally Known _XOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o
Notary Public- State of Florida )
``' RACHELN
DAVIS
Commission No. `i C \ ; 5\
a!1: MyCOMMISSIO
t<PFN9*310
_
No.
f aN:
a
EXPIRES Janu
ry 5, 2019i.
F. RACHEL M DA1
r F-,
(407)9 -0150 FloridaNutary
mice.com
MY COMMISSION #FF11
;S'-.
"•..,,a w,.v
S January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
®UEec
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17