HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
:Perm t Number:
FAIIPLICABLE
J
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: `'l�11 �- .S 0C-f4y, 0 # ,S�u#4y-e G 4hRZ,
Property Tax ID 4: �/ SG a - S_O / - ) (j G c-1 - GUO Lot No.
Block No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
c e- ry 131&4-LJ
�-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
MM hanical _ Gas Tank _ Gas Piping _Shutters -Windows/Doors
_✓ Elecct ric _ Plumbing _ Sprinklers _ Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Gd Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ✓ (
Name:John Law
Address; '19 / r 06" D /! a
company:Law's Electrical Service Inc.
City: �'e�ss•. ?�-rt-4, State: �/
Address:5158 NW Primm St
Zip Code: .3'7 9 S 7 Fax:
City: Pt St Lucie State: FI
Phone No.
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail:
Fill In fee simple Title Holder on next page ( if different
E-Mail)ohniew5158@aol.com
State or County License EC 13006370 29432
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
It value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Name:
Address:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER:
Name:
Address:
City:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
1 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 an 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
commencingpork Or FeLLPIU1119 YUUi 1VUL11.c ur
f�
Signat4* of Owner/ Lessee/Contractor as Agent for Owner
Signature ofiffantractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
by
The forgoing instrument was acknowledged before me
this 2LIday of�6 �;,,5 .20,A(by
this _day of .20_
Name of person making statement
OR Produced Identification
Name of person m king statement
Personally Known OR Produced identification
Personally Known
Type of Identification
Type of Identification
Produced
Produced
f Notary Public State of Florida)
(Signature of Notary Public State o
�'� RACHEL
DAVIS
Commission No. -`. ' a 1 MYCOMMISSIO
V*Mo
2019
No
RACHEL M DA
EXPIRES Januo
ry 5.
1
i�:, +'I MY COMMISSION #FPt
(407)39e-0153 FiorWaNcltary&
mice,com
.� f. ES January 5,
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION
REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17