HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �y a`z Permit Number:
Application
Planning and Development Services
Building and Lode Regulation Division
2300 Virginia Avenue, Fort Pierce F134982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: l.2- 9 I Nr H/-&X A 1" 1'
Property Tax ID #: �/ SUS 9-O 1 - l `/ 79 - GOO -'1
Site Plan Name:
Project Name:
DETAILED DESCRIPTION Of WORK:
r�
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
(,Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
V
Cost of Construction: $ (JD o
_ Gas Piping
_ Sprinklers
Lot No.
Block No.
Shutters —Windows/Doors
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 0c,",tU l YL 4sg2rzrd
ame:John Law
company: Law's Electrical Service Inc.
Address:5158 NW Primm St
Address: /0&3 Ale,:!fle, i3%.C/
City: 3e'0srn I2t4�11 Stater
City: Pt St Lucie State:Fl
Zip Code: 3 `1957 Fax:
Phone No. / - 3 iI C� - / i - .ECG 6 7
Zip Code: 34983 Fax:
No 772 370 4357
E-Mail:
Phone
Fill in fee simple Title Holder on next page ( if different
E-Malljohniaw515B@aol.com
State or County License EC 13006370 29432
from the Owner listed above)
If value of construction is $2500 or more, a RECDRUEU Notice or Lommencemana'a I=y,.,.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN ENFORMATION:
DESIGNE ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address'
State:
Address:
City:
State:
City:
Zip: Phone'
Zip: Phone
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
`Not Applicable
Name:
Name:
Address:
Address:
City,
3 Zip: Phone
Zip Phone'
,.,�nerinn as Indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a perrna W . W 11--- --
I certify that no work or installation has commenced prior to the issuance of a permit.
St. L cie Coun makes no representation that Is granting a ermtt lli authorize the permit holder to build the subject structure
which 1s in conflict with an applicable Home Owners Association rues, bylaws or ane! covenants chat may restrict or P�hlblt such
structure. Please consult wtth your Home Owners Association and review your deed for any restrictions which may app Y.
inconsideration 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-residentlaluse
for
WARNING TO OWNER. Your failure to Record a Notice of Commencement may result in your pay nH twice
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
Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this J!±day of 71-4-n .2ta_2;2by
Name of person making statement
Personally Known _,� OR Produced Identification
Type of Identification
Produced
Commission No. V T 'LL'
Signature
STATE OF FLORIDA
COUNTY OF
The for Ding instrument was acknowledged before me
this day of ?.N.+ 20� by
Name of person making statement
Personally Known OR Produced Identification
Type of identification
Produced
Notary
RACHELDAVIS
YCOMMISSIO No.
XPIRES Jana ro 5, 2 19
REVIEWS ( COUNTER REVIEW } SREVIEWOR REVIEW VREVIEWON
RACHEL M
MY COMMISSION