HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6ZZOZA. Permit Number:
Planning and Development Services
Building and Code Regulation Division
1300 VlrginiaAvenue, Fort Pierce FL 34981
Phone; (772) 462-1553 Fax: 1772) 462-1578
PERMIT TYPE:
Building Permit Application
Commercial Residential w0000oec
I PROPOSED IMPROVEMENT LOCATION: I
Address: '� SU
Property Tax ID #: 415-0 -), - SU ) - Cj 7 -� 6 C", UO % Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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:
Cost of Construction: $ i GC)
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
OWNER/LESSEE: CONTRACTOR:
Name L d- wi 13 ram', /�v v s c Ls
Address: /Ir
City: 7" c s r ✓d r + State:/
Zip Code: 2 Fax:
Phone No. l- Q-2 -;'IPJ- 7585
E -Mail:
Fill In fee simple TMe Holder on next page a If different
from the Owner listed above)
Building Height:
Name: John Law
Company: Law's Electrical Service Inc.
Address: 5158 NW Primm St
City: Pt St Lucie !;tate: FI
Zip Code: 34,983 Fax:
Phone No 772 370 4357
E -M ail i ohnlaw5158@aol.com
State or County License EC 13006370 29432
If value of construction Is $3500 or more, a RECORDED Notice of Commencement Is rec
If value of HVAC Is $7,500 or more, a RECORDED Notice of C.^mmencamert is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:
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 apermit will authorize the permit holder to build the subject structure
which is In conflict with an 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
or
of
STATE OF FLORIDA
COUNTY OF
ICUutK=x-1
as Agent for Owner
The forgoing instrument was acknowledged before me
this _Qday of Tr v, C 20,1-Vby
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
this Oday of ./ V — c . 20 _-20by
Name of person m;king statement Name of person making statement
Personally Known T/ OR Produced Identification Personally Known _'� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of NotaryPublic- State oi lameddlitt
Commission No. \ - i aff
J4071 796-01 KI
REVIEWS I FRONT I ZONING
COUNTER REVIEW
Rev. 8/2/17
Notary Public State of
RACHEL DAVIS
MY cc ISsilo @iR31 No. `-
EXPIRES Janu ry 5,2019
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
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