HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c2 o Permit Number:
Building Permit Application
Planning and Development Services
Building and Lode Regulation Division
23A0V/rg/niaAvenue, FortAwme A-W9B2
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 700°° =
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 9 30 /t/r- ft/ram /-(/`y
Property Tax ID M. y S^� - Sol - l l l b - 0 Uy y — Lot No.
Site Plan Name: Block No.
Prolect Name:
DETAILED DESCRIPTION OF WORK.•
CONSTRUCTION INFORMATION:
Addltional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ _
M
_ Gas Piping _ Shutters
_Sprinklers _Generator
sq. Ft. of First Floor: —
Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
9uliding Height:
OWNER/LESSEE: G�,•, , 1,. /,I, W, I /e- I CONTRACTOR: l
City: G✓ t r f i°n /n /Sr.r, G State: [[
Zip Code: 7 3 1-/ // Fax:
Phone No. /- 4-f-,
E-Mali:
FRi In fee simple Title Holder on next page ( If different
from the Owner listed above)
Name:John Law
Company: LaWs Electrical Service Inc.
Address:5158 NW Pdmm St
City: Pt St Lucie State: Fl
Zip Code: 34993 Fax:
Phone No 772 370 4357
E-Maill1586eoi.com
State or County License EC 13008370 29432
H value of construedw is $n00 or more, a RECORDED NoUce of Commencement b M
If value of HVAC N $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. 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
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Carl] ncnun ann vi ,ca.v,.an, vu, ,.v....�... ..............__..._..-.
Signal 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 / 7 day of 7cT 20,&Cby
this _1-i day of T„ (: . 20,
Name of person making statement
Name of person making statement
OR Produced Identification
Personally Known l OR Produced Identification
Personally Known
Type of Identification
Type of Identifications
Produced
Produced
of
of Notary Public State of Florida )
(Sign Notary Public- State o
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DAVIS
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January 5,
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DATE
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COMPLETED
Rev.8/2/17