HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABL INFP MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4/A )\6 FermitNumber:
D.;_,
Planning and Development Services
Building and Code Regulation Division
1300 Org/nio Avenue, Fort Pierce FL 34981
Phone; (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Building Permit Application
Commercial Residential xxxxxxxx
I PROPOSED IMPROVEMENT LOCATION: I
Address:
c rT/ <J
Property Tax ID #: y i U v2 — _i—v / / 9A 5 — C,, 6v - -7 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 Plping _ Shutters _ Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:
Cost of Construction: $ SOy
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name 64..1 / 1�- CA.l� G tzv I I v
Address: Z j C7 ! - 7't, V. so. S
Name:John Law
Company: Law's Electrical Service Inc.
12
City: S C, h r N e c i ,l J. State: �
Zip Code: !2 Fax:
Phone No. — 571 fa l U o
E -Mail:
Address: 5158 NW Primm St
City: Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E -M ail i0hn1aw6158@a0l.com
Fill In fee simple Title Holder on next page ( If different
from the Owner listed above)
State or County License EC 13006370 29432
If value of construction Is S25D0 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: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
this )2 - day of M4-�h ,202Wby
Address:
City:
Name of person king statement
Personally Known IZOR Produced Identification
City:
Zip: Phone:
Type of Identification
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
rnmmonrina wnrk nr rprnrdina vnur NntirP of (nmmencement.
................
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 )2 - day of M4-�h ,202Wby
this )A- 20_-,Zpby
Name of person m king statement
Name of person king statement
Personally Known IZOR Produced Identification
Personally Known _ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o
of Notary Public State of Florida
w••' *.
�. RACHEL
DAVIS
_
Commission No. ,1 V \^ 'S>-•,
a MY COMMISSIO
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No.
EXPIRES Janu
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(407)798-0187 FlondaNa"ry&
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Rev. 8/2/17