HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I,i 7 ILA f
Permit Number:
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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: l iyb Ns klV r?lv-i
Property Tax ID#: `iSO.Z— SU / ^ 1_'U3 - (EGG - I Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
17 e44rr k0Cle! Peofe,, In
I 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 Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ /oL O U
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 11VG1/erw/ tl1'a-
Name: John Law
Company:Law`5 Electrical Service Inc.
Address;5158NWPrimmSt
Address: / % 3. 791 9 1-t 1"" f -SAl
t City: Lcra acAnce State:
Zip Code: 7 3'1 7 0 Fax:
Phone No. / ' "/S�/ i q - 7 ..3 1 S
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-MaiUohnlaw5158@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 INFORWATION:
DESIGNER GINEER:
Name:
Address:
City:
Zip: Phone
_ Not Applicable
State:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER.,
Name:
Address:
_ Not Applicable
BONDING COMPANY:
Name:
Address:
_Not Applicable
City:
City:
Zlp: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to aot:ne work ano „u.a„a.,,.,•
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttvy makes no represe Cation that Is granting a permit will authorize the permit hold to build the subject cture
sttrruicctture. Please consult with your Home Oewne Owners sociation andrr�ew your deed for any restrictions ntst whtecsh may applyhi It 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 plan, 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 Iobsite
before the first Inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing.Work or recording your Notice or t,amrrterneMc,,.•
r.
Signature of ontractor/Ucense Holder
Signatiyfi of ownei/ 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
17 day of D" c , 2o_gj by
this / day of V' c • 2GAI by
this
Name of person %ri:^aking statement
Personally Known R Produced Identification
Name of person m king statement
Personally Known OR Produced Identification
T
Type of Identification
Type of identification
Produced
Produced
f Notary Pubic State of Florida )
DAVI'S
No
(Signature yof Notary Pubhc State a
'"= \ RACHEL
Commission No. LE X aycOMMISso
0141FAW
RACHEL M DA�EXPIRESJar
AYCOMMISSION AFFtwry5,2079
iaW} W84153 ROfidaNWS"q
'M
cf IMMQ January 5,
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION WE'
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17