HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /A//7/J+/ Permit Number:
O Mrlf
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 xxxxxxxx
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: -31 -2 ��1br lf(v../
Property Tax ID#: A- -ro /— GSy 3 000 7 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Yl r* a Me 'f !fir ��r% /
Block No.
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
_ Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
4
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
w
Cost of Construction: $ l koa
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name rL03 c n o r C r'
Name:John Law
Address: 1 cc,,, S-f.V,-/.:.v. e �
Company: Laws Electrical Service Inc.
City: 6.4 I (s 4yv State:'P
Zip Code: / a O A 0 Fax:
Phone No. l - npWr -T3 d/7
Address:5158 NW Primm St
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-Mailjohnlaw5158@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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER NGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Address:
Name:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Address:
Name:
Address:
City:
city:
i Zip: Phone:
Zip Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the warn ana
I certify that no work or installation has commenced prior to the issuance of a permit.
build the subject structure
may restrict or prohibit such
is which may apply.
St. Luycie County ma no
which Is in conflict w an
structure Please consult v
the
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 tender or an attorney before
commencing,work or recording our ivouce or L.amirtencciunt..
Signature of ntractor/Ucense Holder
Signatt * of Owner/ lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The fo�gcing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
17 day of Of 5- .20.tLI by
this L! day of V� C 20A( by
this
i
Name of person king statement
R Produced lderntfication
Name of person making statement
Personally known OR Produced Identification
Personally Known
Type of identification
Type of Identification
Produced
Produced
of
f Notary Public- State of Florida )
i DAVIS
(Signature Notary Public State o
RACHEL h
` aIMy COMMISSION
Commission No. a
a EXPIRES Janu
try 5, 2059
NO,
RACHEL M DA
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MY COMMISSION #FF1
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REVIEWS FRONT ZONING SUPERVISOR
PLANS
wa
VEGETATION lK
REVIEW REVIEW REVt
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17