HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6-/// A2 U Permit Number:
• Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xxxxxxxx
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: /y0 /z/'r 1-11ru aiy-'0'
Property Tax ID#: /-/CC/P-' S`o 1 - G3%F, - 600- 2- Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace Existing Meter
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:
Block No.
Windows/Doors
Roof Pitch
Cost of Construction: $ CJ 00 Utilities: _Sewer _Septic Building Height:
OWNE�RAESSEE:
CONTRACTOR:
Name n erE3 4 /� dna+^ t h'J° 71A
Name:3ohn Law
_I _
Address: r-1'1- 76 (�A��, d i .,� %fit —�
Company: Law's Electrical Service Inc.
Address: 5158 NW Primm St
City: t1Vf!'4v1 ?C- State: _LT
Zip Code: '16,791 Ac, 'fax:
Phone No. AG `i
Cit,; Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailjohnlaw5158@aol.com
State or County License EC 13006370 29432
If value of construction Is $2500 or more, a RECORDED Notice of commencement is regwrea.
If 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:
Address:
City: State:
Zip: Phone
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
STATE OF FLORIDA
COUNTY OF
Jr Notice Or L.Ommencemeni.
as Agent for Owner Signature of 6ntractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisIt dayof4-rg .20,{1 by this__Ll dayof%20,Oby
Name of person making statement
Personally Known T/ OR Produced Identification
Type of Identification
of Notary Public -
Commission No. liN 1`. : -�v
REVIEWS I FRONT I ZONING
COUNTER REVIEW
Rev. 8/2/17
Name of personn king statement
Personally Known OR Produced Identification
Type of Identification
Produced
'Of Notary Public- St
RACHEL DAVIS
MYCOMMISSIO �iPlmii3lo No.
EXPIRES Janu ry 5, 2019
SUPERVISOR PLANS I VEGETATION
REVIEW REVIEW REVIEW
REVIEW I REVIEW
RACHEL M DA
I
COMMISSION #FFi
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anuary 5,
9
REVIEW I REVIEW