HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFOo`UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 Z Permit Number:
N.
Building Permit Application
Planning and Deve/opmentServices
Building and Code Regulation Division
2300 VirginkAvenue, Fort PMrce FL 34982
Phone. (772)462-1553 Fax: (772)462-1578 Commercial Residential x000oaor
PERMIT TYPE:
Address:
e T// rV
Property Tax ID #: -/7'-.0 OA - S -O l ' ?22/ " U UG - 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
_ Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_ Gas Piping
_Sprinklers
_ Shutters
_ Generator
Sq. Ft of First Floor: _
Utilities: —Sewer _ Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE: I CONTRACTOR: I
Name (7 a.,+lel,H - S Lc w."d
Address: 7Y 6 /l/ e A//f-/ Lel v.O
City: ( e H s r h i�r� o G State: (
Zip Code:2 `7 4I,F 7 Fax•
Phone No. oxo-l--
E-Mail,
xo.2E•Mail,
FIII in fee simple Title Holder on next page ( H different
from the Owner listed above)
Name:JOhn Law
Company: Laws Electrical Service Inc.
Address:5158 NW Primm St
Clty. Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-MaiilGhntaw51580aol.com
State or County License EC 13006370 28432
H value of construction Is $2500 or more, a RECORDED Notice of Comfnwmsmem 5 req
N value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement 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:
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. L. cie 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
record
STATE OF FLORIDA
COUNTY OF
as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this qday of T'(' V 1 c . 20,1 this Oday of Sv •. c . 20 Aeby
Name of person making statement
Personally Known T/ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State o
Commission No.
REVIEWS
tev.
FRONT I ZONING
COUNTER REVIEW
Name of person making statement
Personally Known _�� OR Produced identification
Type of Identification
Produced
Notary Public- State
RACHEL 14 DAVIS
MY COMMISSIO 410111 No. F
EXPIRES Janu rY 5, 2019
SUPERVISOR I PLANS I VEGETATION
REVIEW I REVIEW I REVIEW
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s '�,; RACHEL M DA
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January 5,
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