HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 % e2 Permit Number:
_:,J
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 Residential xxxxxxxx
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: II P1.4e4a/d L,4he-
Property Tax ID #: l 2 7 SOU 04i' S q - Goa - 7 Lot No.
,3'
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: ; c- A
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
YElectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
o�
Cost of Construction: $ y UO Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name-9, lI y d- �' yr(7tna w ebb
Name:dohn Law
Address: PlAr-tVN LA)
Company:LaWs Electrical Service Inc.
Address:5158 NW Primm St
City: pl' -Cf" L Vc 1 o State: _FJ
Zip Code: 3 `1 9 S.L Fax:
City: Pt St Lucie State: FI
Phone No. 77 3 3 2- 3 11 S
Zip Code: 34983 Fax:
E-Mail:
Phone No 772 370 4357
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Maillohnlaw5158Qaot.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:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
_ Not Applicable
BONDING COMPANY:
Name:
Address:
_Not Applicable
City:
Zlp: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFiDVIT: Application is hereby made to obtain a permit to do the work and installation as n Ica e .
1 certify that no work or installation has commenced prior to the issuance of a permit.
St. L cie County makes no representation that is granting a permit 111 authorize the ermit holder to build the subject structure
whiict is inP ease wnisult any li abllome me Ow ersAssociation
sso ison andru es, byview you deed %a any resi(ts ctio s which maor
ap lyhiblt such
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 {raying 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 fender or an attorney before
commencing —Work or recorcling your Notice vi wrIII ei161=n'='i••
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Signatty* of owner/ Lesseee/Contractor as Agent for owner
Signature ofi ontractorJLicense 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 �day of� 20�/by
this-7dayof -v1,_ 20,,rby
''i�
1
Name of person � /m'aking statement
Personally Known OR Produced Identification
Name of person m king statement
Personally Known OR Produced Identification
4
Type of Identification
Type of Identification
Produced
Produced
bf Notary Public State of Florida)
(Signature of Notary Public State o
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DAMS
Commission No. - r a, r MY COMMISSIO
JFiliiTif31 NO RACHEL M DA
EXPIRES Janu
ry 5, 2019 ° •.
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(4D7) �3-0153 Ftomlaw'lary
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i t ES January 5,
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION 9YEe.
REVIEW REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17