HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3I412 , Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349B2
Phone; (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Building Permit Application
Commercial Residential =000ca
I PROPOSED IMPROVEMENT LOCATION: I
Address:
Property Tax ID #: Lj SU,L -f-o / 02 6 A CUu _�— Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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:
w
Cost of Construction: $ ��(oGr/
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Pitch
OWNERAESSEE:
CONTRACTOR:
Name C li. ( E b e 1, ,
Name -John Law
Company: Law's Electrical Service Inc.
Address: A Ce 72 E K i'w_ ✓L (,,,. O
City: 4e-4 / State: JV7
Zip Code: / `/ U 7I_ Fax:
Phone No. l 116 - !
Address:5158 NW Pnmm St
City: Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail)ohniaw5158@aot.com
E-Mail:
Fill In fee simple Title Holder on next page ( If different
from the Owner listed above)
State or County License EC 13006370 29432
i
If value of construction is $2500 or more, a RtGuRutu notice or commencement is requnau.
if value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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
commencin ork or recordingour Notice of Commencement.
Signatl of Owner/ lessee/Contractor as Agent for Owner
Signature of 6ntractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
thisI Zday of M4R. k 20_2.Uby
The forgoing instrument was acknowledged before me
thisJ.0— dayof 20_2pby
Name of person Taking statement
Personally Known _ OR Produced Identification
Type of Identification
Produced
Name of person Taking statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State o
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REVIEWS
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REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
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Rev.8/2/17