HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s- 111,2,1 Permit Number:
• ' Building pp Permit Application
planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce F134982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential XxXxxxxx
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: l (2
7 A S S
674, tq
h Q LL A-2 Y LL
Property Tax ID #:
Z/ 5- / L -
-LC' -2 -
U 2 .3 G - (2 p Cl - ( 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:
U a'
Cost of Construction: $ a, G U Ci
Sq. Ft. of First Floor:
Utilities: -Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name i�A- t G c ' i lud n G
Address: fo 722 S S. Gcnld y>✓ 91 eyfv
City: Sr✓lcrs 6t'4r'k State: f"I'
Zip Code: 3:-! 4 3-7 Fax:
Phone No. 77)- 9-A ¢Y` Z 8 `1 7
Name:John Law
Company: Law's Electrical Service l nC.
Address: 5158 NW Primm St
City: Pt St Lucie State: Fl
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the owner listed above)
E-Mailjohnlaw5158@201.com
State or County License EG 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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
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 conxict 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
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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 fq�pyping instrument was acknowledged before me
The foVng instrument was acknowledged before me
{mil f!2 by
this S—day of AV4h 20 —1by
this dayof .20'
Name of person m king statement
Name of person king statement
Personally Known OR Produced Identification
Personally KnownORProduced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public -State o
of Notary Public State of Florida I
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DAVIS
Commission No. y l� ; '>>1
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January 5,
REVIEWS
FRONT ZONING SUPERVISOR
PLANS
VEGETATION life.
REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17