HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O`t 0 a 1 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 xxxxxxxx
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION: I
Address:
Property Tax ID #: L/SO a - -50 I - 13 -'�. 6 - O 00 - 5 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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
Total Sq. Ft of Construction:
Cost of Construction: $yy v
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name T�9-i , e c d— tei-tbq M/5�-"
Name:John Law
Company:LaWs Electrical Service Inc.
Address: �( /Z 0 S c -r
'4vi
City: 14Ac ka44s L6o State:,tiT
Zip Code: d 7 k 9 0 Fax:
Phone No. I ' '7 0.4 -- 3 3 cY - 7 `/ 2 3
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 an next page ( if different
from the Owner listed above)
E-Mailjohnlaw5158@aol.com
State or County License EC 13006370 29432
If value of construction Is $2500 or more, a RECORDED Notice of commencement is regwrea.
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
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
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 clothe 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 permk 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 restrict 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
commencer uncut I CLUIU111-M VUU1 nVL.1.vr Zvi„r,,
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SignatL#* of Owneri/ Lessee/Contractor as Agent for Owner
Signature of 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
day of CT 20_,?_. 1 by
_
this _ day of 20by
this
Name of person making statement
Personally Known % OR Produced Identification
Name of person myking statement
Personally Known ' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public State o
of Notary Public State of Florida )
RACHEL
DAVIS
Commission No.` } \ - `_' '1 ? MyCOMMISSlO
lftlo
5. 2019
No..`RACHEL M OA
p�
•. EXPIRES Janu
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try
("1 ''t MYCOMMISSION NFF,
h G') 399-0153 FloritlallotarySi
NiceXOM
.5•
I ES January 5.
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION Ste"
REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17