HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
17
Building Permit Application
Planning and DevdopmentServkes
Building and Code Regulodon Division
23M Virginia Avenue, Fort Metm FL 3082
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential -'0a0000a
PERMIT TYPE:
LOCATION:
Address:
Property Tax ID #: 4/ so -;L-- ,S-G I - O `i -T 2 - C" O ° - 3
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical
_ Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
_ Gas Piping
_Sprinklers
—Shutters
Generator
Sq. Ft. of First Floor.._.
Lot No.
Brock No.
Windows/Doors
Roof Pitch
Cost of Construction: $ o u C" Utilities: _Sewer —Septic Building Height:
OWNER/LESSEE: I CONTRACTOR:
Name 6ce.41of, �
Address: 7 `( ills H/r-j
City: Tr✓1.ftti . h State: L
Zip Code: 3 `� `/ 7 Fax:
Phone No. /'o21IS— 2US— USv?
Wall,
HIJ in fee simple TIMe Holder on next page ( If different
from the Owner Iktted above)
Name -John Law
Company: LaWs Eleeticai SaMce Inc.
Address:5158 NW Primm St
City. Pt St Lucie State: Fl
Zip Code: 34883 — Fax:
Phone No 772 370 4367
E-Maitldhn%w516BQWk.com
State or County License EC 13006370 21432
K wiue of wnwucWn is Snoo or more, a RECORDED Notice of Commaneament Is ru
N value of HVAC Is $7,500 or more, I RECORDED Notice of Cammencament 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 mscananon ds inUiLdlCU.
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
dNJ
I
t' f C mmencement
commencln ork or recorIn our o ce o 0
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 3vdayof T a .20�by this 3c day of �� �- .202aby
Name of person m;king statement Name of person
king statement
Personally Known �/ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of identifications
Produced Produced
(Signature of Notary Public- State o 'of Notary Public State of Florida)
r ..
IFLACHEL DAVIS
Commission Na. ,it \ ( a MY COMMISSIO iRtR�fb'31 No f c - -.•
s RACHEL M DA
EXPIRES Janu ry 5, 2019
MY COMMISSION#FF7
(407) 398,0153 Floridallolary mice.com
January 5,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION GVEs.c
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Rev. 8/2/17