HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 .2 Permit Number: _
•
- 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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: l S• O r4-^ /L #t `^I f1 ,r 5 r'
Property Tax ID q: y G� SO ) p LI — G G 6 - a— Lot No.
Block No.
Site Plan Name:
Project Name: 14/3"r
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
_Mechanical
Electric
— Gas Tank
Total Sq. Ft of Construction:
o� Utilities: Sewer Septic Building Height:
cost of Construction: 5 _ �2 G U — —
Plumbing
—Gas Piping —Shutters —Windows/Doors
— Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
OWNER/LESSEE:
CONTRACTOR:
Name LV
Name: John Law
Address: 4191 S S Orel,-,, Orr' W �-
Company: Law's Electrical Service Inc.
Address:5158 NW Primm St
-Te . r r'
City: „ r �. IQ r ra � State: �
Zip Code: 3 t7/ C2 C:2 Fax:
1
Phone No. -7 �' f1 2 Lt — S7 %-2--
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-Mailjohniaw515B@aol.com
State or County License EC 13006370 29432
i fired
If value of construction Is $2500 or more, a RECORDED Notice of Commencement s requ .
If value of HVAC is $7,S00 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:
State:
City: State:
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 permit.
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St. Lucie County makes no repr went Lion that Is gran ing a permirw ll out awstor end covenants holder to
maydrestrlctbaep oct hI%lt such
which Is in con ict with any applicable
structure. Please consult with your Home Owners Association and review your deed for any restrlctions which may app y.
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
St. Lucie County Amendments.
in accordance with the approved plans, the Florida Building Codes and
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
to non-residential use
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses another
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
be recorded and posted on the jobsite
improvements to your property. A Notice of Commencement must
with lender or an attorney before
before the first inspection. If you intend to obtain financing, consult
commencing -work or recording our Notice of Commencement.
r
Signal of OwneF/ Lessee/Contractor as Agent for Owner Signature of 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 Ja day of 2o_1�/by
this L day of A rr Jam— 20i1 by __,g4_,_q
Name of person making statement
Name of person m_aking statement
Personally Known OR Produced Identification Personal) Known % OR Produced identification
T%
Type of Identification Type of Identification
Produced
Produced
f Notary Public State of Florida I
(Signature of Notary Public- State o
f "" �• ` RACHEL DAVIS _ ...
is
Commission NO. `t- MY COMMSSSto ,pmrm0 No.�,,. t
s I ;11 ° 4l RA :HELM DA I
5, 2016
EXPIRES Janu ry i i•) MY COMMISSION#FF7 37
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FRONT ZONING SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW REVI EW
COUNTER REVIEW REVIEW
E
Rev.8/2/17