HomeMy WebLinkAbout403 holiday permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C 3 aZ/ Permit Number:
COUNTY ' Building Permit Application
Planning and Development Services
Buiiding and Code Regulation DiVisian
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xxxxxxxx
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: Agopy l U 7�2 S- .S 0 c rq •-i Y24- # Q 3 —
Property Tax ID #: Y.-/ !— - 'D oZ G /.;, 6 - U U U - ( 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
Total Sq. Ft of Construction:
G�
Cost of Construction: $ ;? CG O"J
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Nam94Ajre-
Name: John Law
Address:�aS 0,z V 4-/a.P
City; Sri-iltr-. 63C 4c� State: �j
Zip Code: .7119S 7 Fax:
Phone No. i- 860 6 &O 92 7 P
Company -Laws Electrical Service Inc.
Addres5:5158 NW Primm Si
City; Pt St Lucie State: f=l
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail:
Fill in fee simple Title Holder on next page ( R different
from the Owner listed above)
E-Maillohn[aw5158@aol.com
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 I BONDING COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
Name:
Address:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as maicatea.
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
commencn ork or recordina vnur 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 fTQing instrument was acknowledged before me
The foVng instrument was acknowledge before me
107A: (by
this _ day off— 202Jby
this=dayof .20
Name of person making statement
Name of personking statement
Personally Known Produced Identification
Personally Known I —f OR Produced Identification
___tZOR
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o
Notary Public State of Florida j
"C' RACHEL
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Commission No. T \ry '> >�
a - MY COMMISSIOPF'f9i1331
No.
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ry 5, 2019
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SUPERVISOR
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REVIEW
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COUNTER REVIEW
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DATE
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COMPLETED
Rev.8/2/17