HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �/�/3� _ _1 A / Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-ISS3 Fax: (772) 462-1S78 Commercial Residential xxxxxxxx
PERMIT TYPE:
i PROPOSED IMPROVEMENT LOCATION:
Address: / G -VS- S OC+,? r 4 /L At Z 9 Z
Property Tax ID #: 4 / -r/ I — -C-0 /- °p'` �F Y - c'G co Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace Existing Meter pedestal
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Block No..__ --
_Mechanical
_Gas Tank
_Gas Piping
_Shutters
_Windows/Doors
Electric
_ Plumbing
_ Sprinklers
_ Generator
_ Roof Pitch
Iota! Sq. Ft of Construction:
Cost of Construction: $ /
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNE'RI LESSEE:
CONTRACTOR:
Name 54.
Name:dohnLaw
Address:-9 202 Sot �4�<
company:Law's Electrical Service Inc.
�4H
City: />C//�h {44..r /c State: IWF
Zip Code: N r/0 f Fax:
Phone No. -7 tea y `J X c-
Address:5158 NW Primm St
City: Pt St Lucie State:A
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mailohnlaw5158 o:aol.com
E-Mail:
Fill in fee simple Title Holder on next page( if different
from the Owner IIsted above)
I
State or County License EC 13006370 20432
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:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 andcovenantsthat 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
commencine work or recordine vour Notice of Commencement.
TignatyA 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 oing instrument was acknowledged before me
f a (by
The for Ding instrument was knowledged before me
day 20 9 /by
this day of � t 120
this of
Name of person m king statement
aOR
Name of person king statement
Personally Known �' Produced Identification
Personally Known I X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public State o
of Notary Public- State of Florida )
.¢ . RACHEL IV
DAVIS
Commission No. i•• \�r i 7\
MY COMMISSIO
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No. .
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RACHEL M DA
(<W) 798-0153 FlOrirfallotane
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"' MY COMMISSION #)A
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January 5,
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ZONING
SUPERVISOR
PLANS
VEGETATION
OGWEe.0
REVIEW
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COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17