HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL INF MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Building permit Application
Planning and Development Services
Building and Code Reguiation Division
2300Virginia Avenue, Fort Pierce FLM982 Residential xxxxaocxx
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial
DFDIUI IT TVDF
PROPOSED IMPROVEMENT LOCATION:
Address: -78_g N e gl ez i3 )v,
Property Tax to #: ��SU R — SO I ' U S -7 I V
Site Plan Name:
n...7..h Alnme.
DETAILED DESCRIPTION OF WORK:
Replace Existing Meter pedestal
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Lot No.
BIOCK No.
-,.
Additional work to be performed under this permii — check au 1, tat Ol aaPPIY:
Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
(/Ciar•+ri� plurnhine _ SnrinklPrs __, Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _ 6Sy Utilities: _Sewer _Septic Building Height: _
OWNERAESSEE:
nubs».
City: /0,�t /, P 14 State:F(
Zip Code: 3 `/ 47 cl O Fax:
Phone No. 77.2- 83f-1 ! 31
E-Mail:
Fill in fee simple Title Holder an next page i if different
from the Owner listed above)
CONTRACTOR:
Pitch
Name:John Law
rmm�anvL•aws Electrical Service Inc.
Address-5158 NW Primm St
City: Pt St Lucie State: FI
e�no�
Lip Code:
Phone No 772 370 4357
E-MaiijOhntaw6'5b@aoi.com
State or County License EC 13006370 29432
If value of construction is $25M or more, a RECORDED Notice or Gommencemenc is requires.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip; Phone
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: Not
Name:
Address:
City:
Zip: Phone:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby maaeto ooiam a Pernm.o �,n=••� •••--_.._-.__ __ ____ __
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 permit 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 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. 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
commencin orKorrecoroln ourivoucevi w
..._.,.•
f
Signat of 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
by
The forgoing instrument was acknowledged before me
this JJ day of i- 202L by
this 21 day of S9 J- 202.L
_T
Name of person making statement
Personally Known y� OR Produced Identification
Name of person m king statement
Personally Known OR Produced Identification
_
Type of Identification
Type of Identification
Produced
Produced
lk
t Vj. i r: i--
of NotaryPublic State of Florida )
(Signature of Notary Public State
f'"r' RACHEL
DAVIS
r F-`"
Commission No. t >'' MY COMMSSS10p8f@ilt51
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No ,., ,�_
'"3 RACHEL M DA
EXPIRES Janu
ry 5, 2019
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,F ES January o,
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17