HomeMy WebLinkAboutBuilding PermitAll APPLICABLE I FO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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' Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xxxxxxxx
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 41 0c /ye- iyk
Property Tax ID#: `i�� - 5 b l� U,;Z 3 Y 0U0_ U
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Lr-)/ ii. /J U
C C-vsn
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction: $ ./ o U Utilities: _Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name rL 191' 0
Name:John Law
Company: Law's Electrical Service Inc.
Address: 17 '1 by / I mow � %� �
City: ( r, t k .n State: r(
Address: 5158 NW Primm St
City: Pt St Lucie State: FI
Zip Code: 3 y i.? 4/ Fax:
Phone No. I - ` I U i - LJ Sl 85' S X _
Zip Code: 34983 Fax:
E -Mail:
Phone No 772 370 4357
Fill in fee simple Title Holder on next page ( if different
E-Mailjohnlaw5158@aol.com
State or County License EC 13006370 29432
from the Owner listed above)
if value of construction Is $2500 or more, a RECORDED Notice m commencement is reyueeu.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone
State:
Address:
7
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
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Address:
9
City:
City:
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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 apermit 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
ommencin ork or recording our Notice or Commencement.
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 for ding instrument was acknowledged before me The forgoing instrument was acknowledged before me
this F day of 4-rg 20,AV by this _L1 day ofj}� 20_,a_c)by
Name of person m king statement Name of person making statement
Personally Known _ OR Produced Identification Personally Known _ OR Produced Identification
Type of Identification Type of Identification
Prndiirari Produced
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(Signature of Notary Public- State c
Commission No. V V V'ti -;-,\
REVIEWS I FRONTZONING
COUNTER REVIEW
Rev. 8/2/17
F
of Notary Public- 51
RACHELDAVIS
MY COMMISSIOPfRifllY310 No.
EXPIRES Janu ry 5, 2019
SUPERVISORI PLANS I VEGETATION
REVIEW REVIEW REVIEW
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