HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A1 A Permit Number: _
dESOMMWMWAMMWMRA
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 W J
PERMITTYPE:
FPROPOSED IMPROVEMENT LOCATION: '
Address:
e
Property Tax ID #: yS O .2. — Sc; I ` / / `l') - 0 u o - 0
Site Plan Name:
Project Name: _
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
Replace Existing Meter pedestal
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping —Shutters -Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
i
OWNERAESSEE:
CONTRACTOR:
Name GSN
Name: John Law
'r�A� w
Address:y/�� /.Z � �-� /I! /'L1
Company:LaWs Electrical Service Inc.
� Address :5158 NW Primm St
.
/ O.e l w+ 13r'9 1n State: �
.
City: ttw 4'a
Zip Code: 124111 Fax:
City: Pt St Lucie State: F!
Phone No. l' i0 /— 3 ) i' .rAJ0
Zip Code: 34983 Fax:
No 772 370 4357
E-Mail:
Phone
Fill in fee simple Title Holder on next page (if citfferent
E-MaillohnlawSISB@aol.com
State or County License EC 13006370 29432
from the Owner listed above)
If value of construction Is $2500 or more, a RECOROEO Notice of Commenmmem ,3 ,c iu1
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
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
state:
BONDING COMPANY:
Name:
_Not Applicable
Address:
City:
Zip: Phone -
OWNER/ CONTRACTOR AFFIDVIT: Application is nereoy maae co aacam a V, .......
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 strI cture
structurin e. Please cconsult w with your Home Owners Owners Assn Association andrreviewyyour deed fcovenants
any restr ctions which may 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 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&Zork or recording our Notice of Commencemen
.
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 forgoing instrument was acknowledged before me
this jtl_ day of Sao 2o,2L by
this _4_L day of S C�agL 20 -L
Name of person making statement
Personally Known OR Produced Identification
Name of person m king statement
Personally Known OR Produced Identification
_!,.Z
Type of Identification
Type of Identification
Produced
Produced
bf Notary Public State of Florida I
State
(Signature of Notary Public o
'''- v RACHEL
DAVIS
Commission No. E` "�+?�' dd' My COMMISSI
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No w
- `-
EXPIRES Janu
..°OMM
ry 5, 2019
MFtACHSSION ;upki
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(407)39"I/ FlondallotaNS
mice.mm
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' ES January 5,
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION F 1#0111111111MAROWE-0
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17