HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A 7/-9 6 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 I ftlAhrAvenue, Fort Pierce FL 34981
Phone; (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
IMPROVEMENT
Address:
GH/*✓
Building Permit Application
Commercial Residential moo00001
a
Property Tax ID M L/.J^ar -r0 / - 0 &'7 e-/ ^ O &a,(,
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / 90C) Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name/An R. �, 11. i,.,
Name: John Law
'
Address: `-I I;-' A"/ 14 L. 91--/
Company: Law's Electrical Service Inc.
City: M� n C'x 13-rir „L� State: Lz
Address -51.58 NW Primm St
Zip Code: 3V91? Fax:
City: Pt St Lucie State: Fl
Phone No. l 330 7 I y 2 01 f
Zip Code: 34983 Fax:
E -Mail:
Phone No 772 370 4357
Fill in fee simple Title Holder on next page (if different
E-Maillohniew6158aaot.com
from the Owner listed above)
State or County License EC 13006370 29432
if value of construction is 57So0 or more, a mECDRDeD nonce or commencemem 0 requi—
If value of HVAC is $7,500 or more, a RECORDED Nodce of Commencement is requlred.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone
State:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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
commencing work or recording vour Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this �day of�20Z�by
Name of person m;king statement
Personally Known ---,L OR Produced Identification
Type of Identification
Produced
`fir/ /Il'-Z_-Y_,t�G�.-
(Signature of Notary Public- State ol FI j,
. RACHEL
Commission No. b \>'�� a MY CCMMISSI
dA�,,, EXPIRES Jar
REVIEWS I FRONTZONING
COUNTER REVIEW
Rev. 8/2/17
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this$(., dayof ( 20:Zuby
Name of person king statement
Personally Known OR Produced Identification
Type of Identification
of Notary Public- State of Florida
DAVIS _
grpF@*310 i No. t
�, . RACHE
y 5, 2019 L M ON
rice.com
MY COMMISSION #FFI
S January 5,
SUPERVISOR I PLANS I VEGETATION eaalawx'P
REVIEW REVIEW REVIEW REVIEW