HomeMy WebLinkAboutbuilding permitAli APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
�� U s�0 Permit Number:
`- _ n
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone; (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xp a
PERMIT TYPE:
I PROPOSED IMPROVEMENT LOCATION:
Address: / 3 A/c fJLell Ali,�
Property Tax ID #: - S-C) - O 9 9 f- G 0 U Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
t IT/--
CONSTRUCTION INFORMATION:
Additional work to be performed ui
_Mechanical _Gas Tan
_ Electric _ Plumbli
Total Sq. Ft of Construction:
Cost of Construction: S 00
this permit - check all that apply:
_ Gas Piping _ Shutters _ Windows/Doors
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 5
Name: John Law
Company:Law's Electrical Service Inc.
Address: I 11 o 't.eg
Address:5158 NW Primm St
City: State: O 0
City: Pt St Lucie State:FI
Zip Code: Ll SCE 36 Fax:
Phone No. I u 1 ' .7
Zip Code: 34983 Fax:
E-Mail: i
Phone No 772 370 4357
Fill In fee simple Title Holder on next page ) If different
E-MailjOhni"51580-80l.com
State or County License EC 13006370 29432
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION
LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Name:
Address:
City:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State:
City: State:
Zip: Phone:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:
I certify that no work or installation has c
St. Lucie County makes no representation
which is In conflict with any applicable Ho
structure. Please consult with your Home
is hereby made to obtain a permit to do the work and installation as indicated.
prior to the issuance of a permit.
ting a permit will authorize the permit holder to build the subject structure
Association rules, bylaws or and covenants that may restrict or prohibit such
ociation 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, th a 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
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Signat of Owner/ Lessee/Contractor i
is Agent for Owner
Signature of ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowled
ed before me
The forgoing instrument was acknowledged before me
this ?v day of W,11oA 2
ay by
this I& day of 014r, 4 . 20_,Zi by
Name of person Taking statem
nt
Name of person giaking statement
Personally Known OR Produced Identification
Personally Known _ OR Producec
Identification
_+
Type of Identification
Type of Identification
Produced
Produced
F
(Signature of Notary Public- State o
Notary Public State of Florida I
'��' RACHEL
DAVISl33(
Commission No. `E S \r- '- >\
F(407)
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No
EXPIRES Janu
ry 5, 2019
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415.1 Flondallotary
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•...aey„•'EXI
ES January 5,
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FRONT
ZONING
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PLANS
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filQifIi
REVIEW
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DATE
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DATE
COMPLETED
Rev.8/2/17