HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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;0 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
OCDPAIT TVDC-
Residential xxxxxxxx
PROPOSED IMPROVEMENT LOCATION: '
Address:
Property Tax ID #: %r — S`U I I IVS 17 G C) — Lot No.
BioCK No.
Site Plan Name:
DETAILED DESCRIPTION OF WORK:
r^nAi CTo i ir'TI Mhl 1 N M0 aA AT1nrV
AdditfOnai WOCK IO be performed under this permtl- LfiBGK Aii tl rGa a i
Mechanical Gas Tank _ Gas Piping —Shutters —Windows/Doors
FlnMrir al„�,I,Iro Snrinkipm Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ II �D Gy Utilities: —Sewer —Septic Building Height:
f OWNER/LESSEE:
Name4�hE /77 t a
AYY, G.j.i. /1 •%� Alm/ /-r1 /S l✓
city: �-rvr c Zn State:
Zip Code: 3'/ 9 S i Fax:
Phone No. 201%
E-Mail:
Fill in fee simple Tide Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name:John Law
rnmPa y.Law's Electrical Service Inc.
Address:5158 NW Primm St
City: Pt St Lucie State: Fl
_ zAnvz
Phone No 772 370 4357
E-MailJohniaw515n{ti�aci.com
State or County License EC 13006370 29432
If value Of construction is s2sou Or more, a RECumuhu NOiiCe Or LOmmenremerrl u rzgwa+ -
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:.
BONDING COMPANY:
Name:
Address:
State:
—
_Not Applicable
City:
Zip: Phone
FEE SIMPLE TITLEHOLDER.
Name:
Address:
City:
State.
_ Not Applicable
City:
Zip: Phone:
__� e..e..lf�einn ae int ir2tari
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do Tne wom
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure, Please consult with your Home Owners Association and review your deed for covenants
ny resttriictions buy restrict applYhibit 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 plools,ofences, wal sexempt
signs, cr en rooms and accessory uses to notherr non-residential use
accessory structures, swimmingg p
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 lobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing.vvorkK or recording our Notice of Commencement.
n
Signature of ontractor/License Holder
Signat of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY Of
COUNTY OF
The forgoing instrument was acknowledged before me
by
The forpotng instrument was acknowledged before me
this Zday af S=!7__ 20_( by
this 1_rdayaf Ste— 20,21j
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known TfOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Noary Public State of Florida
(Signatureof Notary Public State o
RACHEL III
DAVIS
Commission No. V i- My COMMISSIO
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No
FtACHEL M DA
•.ter l EXPIRES Jana
kry S. 2019
•, MY COMMISSION #FFt
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(407)aHa-0S 53 Floritlx4c#aN
Nic Cam.,
.'
I January 5.
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION QWE80
REVIEW REVIEW REVIE
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
'
Rev. 8/2/17