HomeMy WebLinkAboutBuilding Permit Application All APPUCA13LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _-2 Permit Number:
=011411111'__
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial ResidenlNo
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:_ 20) I tic HI'r-r e1vProperty Tax ID#: VSQA - ,-0 /- Oc-/"7'7 G6 0 �
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 T Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 0 ri u Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 4 r.S c /^r Name:John Law
Address: 1 1 / �0 E 4v,9S1�rir9 / S f Company:Law'g Electrical Service Inc.
City: S } C L r 4 r!^ FA (J State:—ff Address:5158 NW Primm St
Zip Code: 1-/L/6 a 3 Fax: City: Pt St Lucie State:FI
Phone No. Zip Code: 34983 Fax:
E-Mail: /- ryyv '705� 000 ? Phone No7723704357
Fill In fee simple Tltie Holder on next page(II different E-MaiUohnlaw5158@aoLcom
from the Owner Rsted above) State or County License EC 13006370 29432
Ii value of construction is$2S00 or more,a RECORDED Notice of Commencement is required.
Ii value of HVAC is$7,500 armors,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 TITLEHOLDER: _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,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
commencing4ork or recording our Notice of Commencement.
Signat of Owner/LesseefContractor as Agent for Owner Signature 014ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The ylpring instrument was acknowledged before me The forming instrument was acknowledged before me
this d_day of_ Gr/q_ 4 20 41 by this 3=day of !'1'lif7 .202r by
Name of person making statement Name of person making statement
Personally Known---,,ZOR Produced identification Personally Known_AZ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State o of Notary Public State of Florida)
r y..
3� RACHELN DAVIS
Commission No.Is V\ > i Ar MY COMMISSIO PMWgo iNo.
red EXPIRES Janu try 5,2019 ,�`"Y ', RACHEL M DA I
" "- MY COMMISSION#FF1 7 1
(dOl)�9Bd1S3 F)oridallolary l a.rom `y-,
'*,,,as w,,.r"+ S January 5, 9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ROWS-ex
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17