HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Building Permit Application
(Planning and Development5ervlces
i Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xxxxxxxx
DCORAIT TVDr.
_ i
iI I PROPOSED IMPROVEMENT LOCATION:
Address:/y / -r
Property Tax ID M. •-G ! ` 1 r' 3 7 GU C, - 7 Lot No.
Site Plan Name: BiocK No.
I�
DETAILED DESCRIPTION OF WORK:
�r Replace Existing Meter pedestal
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I�+
rnA1fT01 IrTlnAi IRICMDUATIMd
Addittonai work to be performed under this permu— Check Gil liidt apllAy.
—Mechanical Gas Tank _ Gas Piping _Shutters -Windows/Doors
✓ 1-. Ae nh,mhina _ 5_nrinklarc Generator Roof Pitch
IITotal Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ c'()o Utilities: —Sewer _Septic Building Height:
1
�IName—Fj-g-�vrr/
I�City:
i
OWNERAESSEE:
P,C
CONTRACTOR:
i Name -John Lew
I rnm LaW5 Electrical Service Inc.
nany' _ -
i Address: 5158 NW Primm St Ij
1
" J-1-.. � I �S .i � %�A ✓7 R� Y; T r.-rq�
State: FV
Zip Code: Fax:
Phone No. e't rr
City: Pt St Lucie State: FI
aanaa
I "P Ill. l 772 370 4357 « 1
I Phone No 1
E-MaiiJohniawN516ts@aoi.com
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
i
' State or County License EC 13006370 29432
If value of construction Is W500 or more, a RECORUtu Nonce oT wmmencemenx u royuil cJ.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER NGINEER:
Name:
i Not Applicable
(MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 of a permit.
no
the permit holder to build the subject structure
and covenants that may restrict or prohibit such
led for any restrictions which may apply.
Inconsideration 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. Lurie 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
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(.uif1I11C11C111 VIR VI ICLVI YIII VVI ,�Vbw� V, u.Vr..0 rurr.......-.
[4SIgnatof
owner/ 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
5,20�j by
The forging instrument was acknowledged before me
this Zday of 5T 2a�( by
this Ltdayof
Name of person? mFaking statement
Personally Known 4r' OR Produced Identification
Name of person making statement
Personally Known i., z OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
State
of Notary Public State of Florida )
(Signature of Notary Public o
RACHEL
DAVIS
Commission No.1 V ' > `, ` a. MY COMMISSIO
;FiPPW*.4
No - """"
'FtACHEL M DA
owa EXPIRES Janu
ry 5. 2019
:" i•I My COMMISSION#FF1
(4W1 M-015 Fkxii Notary
niCe.c M
3_ --. r
7 S January 5,
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
PLANS
REVIEW
VEGETATION
REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17