HomeMy WebLinkAbout491 nettles permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: kL) /-Z t-) Permit Number:
Building Permit Application
Planning and Development services
Building and Cade Regulation Division
23W WrilniaAvenue, Fort Nerce FL 34982
Phone; (772) 462-1553 Fax: (772) 462-1578 Commercial Residential '0 wOm
PERMIT TYPE:
ENT
Address:
Property Tax ID SD a- rU ( U 7 7 Uo u 7
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
r
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ _
_ Gas Piping
—Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: I CONTRACTOR: I
Name 1zyA ILre-1 Lh rr_LI-C
Address: S- Ly 7 ff� M4 i,, LN
City: Lv • i.J; 01 i is State: _& r
ZIP Code: , `-/ °1 �/ �i Fax:
Phone No. (o I (o - & 3 (o - 13 R ;y
E-Mail:
Fl11 in tee simple Title Holder on next page t If dlfferwd
from the Owner listed above)
Name -John Law
company-Law's Electrical Samos inc.
Address-5158 NW Primm St
City: Pt St Lucie State: Fl
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail)ohnlew6158000t.00m
State or County Ucense EC 13006370 28432
N value of eonstmetion is $Boo or more, a RECORDED Notice of Commencement b M
if value of HVAC D $7,500 or more, a RECORDED NaVice of Commaneement 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. 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
—L — ..rrlln vnnr Nntiru of rnmmonram Pnt
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Signato 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 30+ day of —T-N e- . 20_2
this � day of � +- . 20 zo+by
Name of person making statement
Name of person making statement
OR Produced Identification
Personally Known �� OR Produced Identification
Personally Known J/
!—
Type of Identification
Type of Identification
Produced
Produced
(Signature of NotaryPublic- State o
of Notary Public- State of Florida I
RACHEL
DAVISpl,
_
Commission No.'c ? \ -.
f a ° MYCOMMISSIO
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No.
' yt RACHEL M DA
EXPIRES Janu
ry 5, 2019
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MY COMMISSION
iy
p01) 398-0153 FbnrfallotaryS
Nite.cDln
i�•
January 5,
5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
Qlilliie.ci
REVIEW
REVIE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17