HomeMy WebLinkAboutBUILDING PERMIOT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L Jp
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 xm
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION: '
Address:
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Property Tax ID #: v -�-O .)- - -S`O / 0'�FAq O G -
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace Existing Meter pedestal
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
—Mechanical
Electric
— Gas Tank
— Plumbing
Total Sq. Ft of Construction:
— Gas Piping
— Sprinklers
— Shutters
_ Generator
Sq. Ft. of first Floor: _
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: Sewer
Cost of Construction: $ a.,Gycl — —Septic Building Height:
OWNER/LESSEE: _
CONTRACTOR:
Name L •lUh re%-e -
Address: '9 9G /(/e &J/ -f /J/-./
Name: John Law
Company:Law's Electrical Service Inc.
Address:5158 NW Primm St
City: -TC NJ:w ({r,g-,G, State:,
c
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Zip Code: Fax:
Phone No. 7 7;�- 'If f 6 S! I
CitY: Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Maiiiohniaw5158Qaol.com
State or County License EC 13006370 29432
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if Value of Construction Is $2$00 or more, a RECORDED Notice Or L0Mn1CnLCMeM Is r equ.. �..•
If value of HVAC is $7,SW or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip; Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is nereoy mace co cocain a I,�,,,,,.I-
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 permtt holder to build the subject structure
which is in cc Mict with any applicable Home Owners Association rules, bylaws or antl 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
commencin ork or recording your Notice ui CuI11ir10i16G
Signature of ontractor/license Holder
Signato 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
The forgoing instrument was acknowledged before me
2a,2L by
this 2Ldayof ;1 .20.1L by
thisAill_dayof Seo�
Name of person king statement
Personally Known OR Produced identification
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Notary Public State of Florida )
(Signature of Notary Public State o
le"„ RACHEL III
DAVIS
Commission No. MY COMMISSiO s 14° a
r
RACHEL M DA
EXPIRES Janu
try 5. 2019
. t
i MY COMMISSION #FF1
I<0'n 398-0153 Fbritlallotary
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ES January 5,
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION SdEe.c
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17