HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLIC, :TION To 9E ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce tt s4981 r v. e u xx
PERMIT►YPE:
PROPOSED IMPROVEMENT LOCATION:
Property Tax ID fl• `i S'0 � S'0 /' G 0 0 0 G u D .� a
Site Plan Name:
O.,.f.>.•f Rlamo•
CONSTRUCTION INFORMATION:
Additional work to be performed unuei ills iier filii — Ci1cGk ail ti di a}]�i'r:
_Mechanical _ Gas Tank _ uas -ipmy `Shutters
_ Electric — Plumbing _ Sprinklers — Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
G d
[ner of rnnstr�uctinr r C _. C> U Litiliti¢s: ._. Sewer _ Septic
OWNER/LESSEE: _ `CONTRACTOR:
F. mow: HSG R'L -`FI
Zip Code: 2 `/ % % Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( If differem
from the Owner Ili -tea above)
Lot No.
Block No.
dindovw>2"-''��-
Root Pitch
Building Height: -
Name -John Law
r LaWs Electrical Service Inc.
a.ra„r�.5t58 I4!1A1 Primm Sf
City. Pt St Lucie
Zip Cade: 34983
Phone No 772 370 4357
E-Maiilohniawal b8gaol.00m
c.e or Cn,;n:r Licsnse
If value of conAmcdon Is $2500 or more, a RECORDED Notice of Conmencement is required.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
Fax:
State: Fi
L
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
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 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, 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
commencin-or k or recordin our Notice of Commencement
Signat of Owner/ Lessee/Contractor as Agent for Owner
Signature of 0ntractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for cling instrument was acknowledged before me
'this
The for cling instrument was a{knowledged before me
/ `a_Z by
day of CIO--t f . 20 2 c by
this J�, day of � e .20
Name of person mFking statement
Name of person king statement
Personally Known person
Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
-�=�'' l.t e .t 'f,J � Y, c `_=, `
-l�i'>�- j t%% lt� I.t✓ �,�_...
/
(Signature of Notary Public -State o
f Notary Public State of Florida )
RACHELIV
DAVIS
Commission No.y \` 1
1 My 00MMiSSiO
9PPWI§3i
No t -F. < '•
.' EXPIRES Janu
ry 5, 2019_"
4�4 RACHEL M DA
(107)396-0153 Floridallotary
IMMM
s MY COMMISSION#FFt
k1
I ES January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
80V6c
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17