HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: & / Permit Number:
S , J
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AIM
Planning and Development Services
Building and Code Regulation Division
2300 VirginiaAvenue, fort Pierce FL 34992
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Building Permit Application
Commercial Residential xxxxxxxx
Address: A
!'%i'r i
ze, 4
Property Tax ID #:
CI s G -
.S'O l -
G G 6 7 - O D D - `T Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace Existing Meter pedestal
CONSTRUCTION INFORMATION:
Additional work tribe performed under this permit - check all that apply:
_Mechanical
_ Electric
_ Gas Tank
_ Plumbing
Total Sq, Ft of Construction:
v-
Cost of Construction: $ A GUU
Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
'OWNER/LESSEE:
CONTRACTOR:
Name /F/o u n/ I- Sc r�E fn C sz -9 — ,f h
Address: �17r /2/ s �z , —
Name: John Law
Company, Laws Electrical Service Inc.
City: ry a�vh 'g State: L y
Zip Code: / 4/ 0 (0 3 Fax:
Phone No. / 7 / (b' 6.2 7 - r/ 4-1 V 7
Address:5158 NW Primm St
City: Pt St Lucie State: FI
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-Maiilohntaw5158@aoLcorri
State or County License EC 13006370 29432
If value of construction is 52500 or more, a RECORUEU IYOtice Or LOmmencement is requaeu.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City; State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip; Phone -
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to cotain a perms co ao me wurK dnu
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 andcovenantsthat 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
_ __.__ ___:__ ... _.-�. __ ..___dt__..,.. ,. Kt..ri.•e ..f rnmmunro most
commenGm UI&Ur FULUIU If 'A YUU nwt'.c
Signat of Owner/ Lessee/Contractor as Agent for Owner
Signature cf ontractor/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 I Wdayof 7�r c 20�r by
this I fdayof T r c 20�i by
Name of person m king statement
Name of person J //making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
"Z
Type of Identification
Type of Identification
Produced
Produced
#
of Notary Public State of Florida )
(Signature of Notary Public- State o
RACHEL
DAVIS
Commission No. V a MYCOMMISSIO
,iP-MtR�?I�31
Nod n•n
RACHEL M DA\
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ry 5, 2019
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MY COMMISSION #FFii
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REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION111 AYEe.
COUNTER REVIEW REVIEW
REVIEW
REVIEW REVIEW REVIE
DATE
RECEIVED
DATE
COMPLETED
Rev.812/17