HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / / `/ 2 Permit Number:
J
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ResidentialDOOIX
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: yes //0 #/-rJ
Property Tax ID #: -7
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
rnwrTRtlrTi0N INFORMATION: -
Lot No.
Block No.
Additional work to be performed under this permit - check all that apply:
_,Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Wfndows/Doors
_ Electric _ Plumbing —Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
o
Cost of Construction: $ Utilities: _Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Ivi r
Name: John Law
Company: Law's Electrical Service Inc.
Address:5158 NW Primm St
Address: po ik / q 7 O
City: pIL plr/fi c 4 9Y a .+c L, State: YT
Zip Code: 09 i 412 Fax:
City: Pt St Lucie State: Fl
Phone No. /- a 0 /— 7 `/ ! - /v 1-2-
Zip Code: 34983 Fax:
No 772 370 4357
E-Mail:
Phone
Fill in fee simple Title Holder on next page (if different
E-Mail)0hnlaw51580_aol.com
State or County License EC 13006370 29432
from the Owner listed above)
If value of construction is $2500 or more, a REGUNUeu notice or Lommencnma„• ,. ,=y..'.
If value of HVAC is $7,SW or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFOWATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
` Not Applicable
Name:
Address:
Name:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Address:
City:
Name:
Address:
City:
Zip: Phone:
`Zip: Phone'
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11 iac indirmtori
OWNER/ CONTRACTOR AFRDVIT: Application is hereby made to obtain a permit to oo tr,c
I certify that no work or installation has commenced prior to the issuance of a permit, ��1i�
St. L. tie Counttyy makes no repr iicenbleiHome oiwners Asgocpatlo nruwieis,alry a or and covenants tirat build
Prohiblct such
which is to contact with anY app
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 ail 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 mutt 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
as Agent for Owner I Signature
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this 1j day of 20-2.2by
Name of person m king statement
Personally Known OR Produced Identification
Type of identification
Produced
(Signature of Notary Public State o tRACH 3L
Commission No. V 5 bFY GOMMISSI
EXPIRES jar
REVIEWS
Rev.
r
STATE OF FLORIDA
COUNTY OF
The forggo�ing instrument was acknowledged before me
this / `7 day of 7 9. 2o" by
Name of person making statement
Personalty Known ' OR Produced Identification
Type of Identification
Produced
of
OA6>
lisillyWop No i.;,
"" RACHEL M
,.
y?.I MY COMMISSION
FRONT ZONING COUNTER REVIEW I SUPERVISOR
R I REVIEW PLANS `VREViEWON Ii9 REVIEW