HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /A h71A a Permit Number:
COUNTY
Planning and Development Services
Building and Lode Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Building Permit Application
Commercial Residential xx=xxx
I PROPOSED IMPROVEMENT LOCATION:
Address: 6 YO /%a iy1il fl1v/
Property Tax ID #: '%Sra 'et ^ J"O /— G J�' 2 6 - 0 Go - 7 Lot No.
Site Plan Name:
Project Name:
Block No.
I DETAILED DESCRIPTION OF WORK: I
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: _
v�
Cost of Construction: $ I s-00 Utilities: —Sewer —Septic
-Windows/Doors
Roof
Building Height:
Pitch
OWNERAESSEE:
CONTRACTOR:
Name /�i ti=�6,�, G ii,#hp- tv,..
Address: h, /22
City: State: �
Zip Code: !/pit �/ 3 Fax:
Phone No. !7a1 907 - A 3 A6
Name -John Law
Company, Law's Electrical Service Inc.
Address: 5158 NW Primm St
City: Pt St Lucie State: Fl
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-Maiijohniaw5l58@aol.com
State or County License EC 13006370 29432
If value of construction is $2SD0 or more, a RECORDED Notice of Commencement Is required.
If value of HVAC is $7,SW or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
^
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 w h 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
commencing,work or recording our Notice of 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 forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this __I_ day of &rr; 20Aeby
this 'Iday of Ofc. 20�20by
Name of person m akin statement
Personally Known OR Produced Identification
Name of person making statement
Personally Known _ , ! OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
tr' •.L-_y-'
�_o[-IfL�0
(Signature of Notary Public- State-0
of Notary Public state of Florida
fM' RACHEL
DAVIS
Commission No. � F 1` i `>°3l
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No- F `
EXPIRES Janutry
5, 2019
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Rev.8/2/17