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Date: ! Permit Number:
Building Permit Application -
Planning and Development Services
8uiiding and Code Regulation Division
2300 Virginia Avenue,Fart Pierce Ft 34986
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�� PERMlT TYPE:
PROPOSED IMPROVEMENT LOCATION:
11 -71 /V r- 41 rI /31 L,,,/ _ Il
Property Tax ID#: Lot No.
Site Plan Name: Block No.
1! Pn%'C!.t r,ntlw..
: ire c°4 uL�.e;>. s tne.rne a&ai`c a-• i If
I1� J Ve.fn:c.�s, ...weie etva.r vsr }
Replace Ex€sting Meter pedestal
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CONSTRUCTION INFORMATION:
pddirionai work to be performed urtuer ufis jJrrriirL ureWi all!Prrat alr!`ily:
Id „JleLnani-^_ � f-4,•T?n4 C'aC piping _�€:iJtferS � vtii�iu'iUVd5/CJG(s15 �
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Electric Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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9 Costo#, rR„cr. acti n G/- S U irtilitle=: __ Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name wkw,r r Name:john Law I ��
3 ra a, Electrical Service Inc.
_..g158 krw Prlmm St
Zip Code: Fax: j City: ri SL Lucie bta1e;_
Phone No. I— S-SS— 7;t-7— 3 !3- Zip Code: 34983 Fax:
E-Mail, t Phone No 77723704357
11 Fill In fee simple Title Holder on next page(if different F MallJohniaww 58(Waoi.com l
it w.9432 I t3
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
tf value of HVAC is$7,W or more,a RECORDED Notice of Commencement is required.
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JVr rLLIVIL IN 1 P 1_ LVtVJ 1 IZVL I IVIr itbrr L yr urt vrvrl/1trvtr.
DESIGNER/ENGINEER: `Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: — , City: State:
7irr Phrme I Zin: Phone:
FEE SIMPLE TITLEHOLDER: ,Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: _ City:
Zip: Phone: Zip: Phone:
I I i
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.
5t.Lucie Countyyy 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.
Inconsideration ot the granting otthis requested perms, i cio hereby agree cnaL i will, h ail ry Ncde, W� :cra t`e acr!:
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
betore the tirst inspection. It you intend to obtain financing, consuii wiii, Ienucl ul 011 oiutii ICS( W=forI
commence ork or recardlnyour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of„eontractor/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�Coday of 4P-1 ,20 At by this 2?,(2 day of i9d—v —^—20 `d by -
I
Name of person Taking statement Name of person making statement
Personally Known OR Produced Identification Personally Known FOR Produced Identification
Type of Identification Type of Identification
Produced Produced
I
.�.�,y .
(Signature of Notary Public-State o Of Notary Public State of Florida
RACHEL b DAVIS
Commission No. \ { MY COMMISStO ;M No 4.. ' ' ,in, —'fSeCH
;s r EXPIRES Janu�ry S.2019 +'' '_ ftACFiEL M DA i
- = My COMMISSION#FF1 7 1(ADT T19 M53 PloridaNnl�ryS rvice.ccm L..-._ lri-
-•;,e ` �nco.iarruary 0, *J
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION QW&
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIE
DATE
RECEIVED
DATE I
I GUIVIYLtItU I I I 1
Rev.8/2/17