HomeMy WebLinkAbout170 hoilday permitAll APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 A % eZI Permit Number:
5 J71
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Building Permit Application
Commercial Residential xxxxxxxx
Address: / 0 G C 1-4y, &et # / "7 C-)
Property Tax ID #: _5'U / ^ G X J- 3 - CHUG - 6 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Block No.
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
p- ✓
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Pitch
OWNERAESSEE:
CONTRACTOR:
Name 0,1 y,,P y, L, v lf2
Name. John Law
Address: 2
Company: Laws Electrical Service Inc.
Address:5158 NW Primm St
City: 6, 1- IZati a ., State: 0A1
Zip Code: /Vo G - I lwty Fax:
Phone No. S' 32
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 I if different
from the Owner listed above)
E-Maillohnlaw5158@aol.com
State or County License EC 13006370 29432
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: j
Name:
Address:
City: State:
Zip: Phone
SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip; Phone: —
BONDING COMPANY: _Not
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby maae to ooram a PCr r.,,. LV _ ��• �••- •• - - ---
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy makes noyyreprese tation that is granting a permit will aut}�orize the Or permit holder to build the subject structure
structture. Please consult wlthpyourHome Owners Assoc atiion andrrev ew yo Sc deed for any restrictions which may approhibit 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
commencing -work Or recorcling your Notice of t.ornaml
.ri n=: r••
j� /�
Signature of ontractor/License Holder
i
Signatusk 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
Nw 20 at by -
this � day of AIU LI .20p_L 1 by
this o_t 7day of .
Name of person making statement
Name of person making statement
OR Produced Identification
Personalty Known _ OR Produced Identification
Personally Known
Type of Identification
Type of Identification
Produced
Produced
bf Notary Public State of Florida )
(Signature of Notary Public State o
iPei - RACHEL
DAVIS
No '
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Commission No. V V : - - MY COMMISSIO
9rFTf
RACHEL M DA
? a F EXPIRES January
5„ 20t9
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•' '( MY COMMISSION #FF1
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"�-'' t S January 5,
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION AVEre.
REVIEW REVIEW REVIE
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17