HomeMy WebLinkAboutBuilding Permit Application Ail APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 � I Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34S82
Phone: (772)462-1553 Fax: (772)462-1S78 Commercial Residential xxxxxxxx
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 'I A/C! Hl-r-s /wr./
Property Tax ID##: S O — .S-O r✓ U Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace Existing Meter pedestal
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:
c�
Cost of Construction:$ /��0 7-- Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: / CONTRACTOR:
Name s od- avr - Name:3ohn Law
Address: 3,�f CJ X4' No. /4 SG,�L /31-V Company:Law's Electrical Service Inc.
City: Stater Address:5158 NW Phmm St
Zip Code: Xh Fax: City; Pt St Lucie State;FI
Phone No. 702 P/a- 3 0 S7— Zip Code: 34983 Fax:
E-Mail: Phone No 772 370 4357
Fill in fee simple Title Holder on next page I if different E-Maillohnlaw5158@aol.com
from the Owner listed above) State or County License EC 13006370 29432
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,1 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 for D nt ing instrument was acknowledged before me The forgoing instrume was afknowledged before me
'this day of de -, f ,20 a c by this_22-day of 20 a by
Name of person m king statement Name of person king statement
Personally Known�JOR Produced Identification Personally Known R Produced Identification
Type of Identification Type of Identification
1 Produced Produced
(Signature of Notary Public State o of Notary Public-State of Florida I
RACHELN DAVIS
i
Commission No.} F" a = MY COMMIS510 ffPFR91331 No.
[EXPIRES Janury 5,2019
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(407)398-0153 Flwidallotary mice.mm i_y._ i MYCOMMISSION#FF7 7 1
January 5, aC9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION GWEe.c m
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIE
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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