HomeMy WebLinkAboutbath house 7 permitAll APPLICABLE I FO Usr BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -C o� Permit Number:
tit tiY l� ♦ � �.t.
Building Permit Application
Planning and Development Services
Building and Code Regulation DAdsion
2300 W rg/nieAvenue, Fart Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential'G000000`
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 'I ?C"I ( Ct/-iv+ {2`2 IV,4f-In H&f sc 17 -
Property
Property Tax ID #: L/ S-� - S'0 I - ) b o l - o G 2 - G
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
C
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: $ !;-SO J
_ Gas Piping
—Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
/�
Name U1'� ✓ate rl CSG f4 E /Ue N/"a .2s la
Name:JO'n Law
Address: Tirol C. C1 . rA h ✓l e, _
Company: Law's Electrical Samoa Inc.
City: -Tr. j r-- t9 t-4 �� r / State: _
Address- 5158 NW Primm St
may: Pt St Lude State: Fl
Zip Code: Fax:
Phone No. -Z C — a2 GI ? l -
Zip Code: 34983 Fax:
E -Mall:
Phone No 772 370 4367
pill in fee simple Title Holder on next page ( If different
E-MailfOhniaWS158400tEr"
State or County License EG 1300837() 29432
from the Owner lined above)
_.J�J
if value of construction is $1500 or more, a REGOf M Notice of Conmtencement m ,vgnn w.
if value of HVAC Is VAN or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGIN EER: _ 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. L4cie County makes no representdtion that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with au 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
mm.mina .mrl, nr rcrnrrlina vnitr Nlntlra of rnmmPnrPmPnt.
�_ _
__
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 fore2mg instrum nt was acknowledged before me
this �Lday of �., ZQQby
The forgoing instrum nt was acknowledged before me
this ,�_" day of .J 2020 by
Name of person making statement
Name of person making statement
Produced Identification
Personally Known L OR Produced Identification
Personally Known OR
_
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o
of Notary Public State of Florida )
r,.•r" ' RACHEL
i ? a
DAVIS
Commission No. 4- � \
a 1 MY COMMISSIO
�oWad�'
gppp@*Oo
iNo.-
RACHEL M DA
EXPIRES Janu
try 5, 2019
-MY COMMISSION OF
(40]) 798-0153 Flontlallotary
rvice.com
S_.
�_t't7-01
IRES January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
®ilEe
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17