HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l/ 'ti O Permit Number:
COUNTY
r a n a I c
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
i, S fi � i
Commercial Residential xxxxxxxx
Address: / -- l S IN A_
Property Tax ID p:
j-
D 3 6
- 0 U v— 7
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / S-Gy o• Utilities: _ Sewer _ Septic
—Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name PAS % d' TAn 1.6*r. La '
Name:John Law
Ide
Address: / / 3 Gv / sf S
Company:Law's Electrical Service Inc.
City: Cz I Pr ere r' _ State: j
Zip Code: 3-/ % `�� Fax:
Phone No. `/O 80 1
Address:5158 NW Primm St
City: 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 KtcUKutu Notice or Lommencemem 1D , eyu i cu.
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 Counter 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
�1. _4;_ r of rnmm cnrn ment
CO 111111 ai. C 111 VIA VI IGYVI ...............
Signat of Owner/ Lessee/Contractor as Agent for Owner
Signature of ontractdr/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
day 4v 20a_Uby
thisday of .4✓9 20,2&by
this 1l of c9
Name of person m king statement
Name of person king statement
Personally Known nOR Produced Identification
Personally Known �OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�
I
(Signature of Notary Public State o
of Notary Public State of Florida )
4 RACHEL N
DAVIS
_
Commission No.
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Janu
ACM0§00
5, 2019
No ) `� -
1• -° RACHEL M DAB
EXPIRES
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{y, � MY COMMISSION #FFt{
IRES January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SWEe.e
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17