HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: of Z 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 DOOIX
PERMIT TYPE:
i PROPOSED IMPROVEMENT LOCATION:
Address: --<=- C 3 ,�7 tic hl-e
Property Tax ID #: 4y S'0 a.- .Sb ) - G 7 A r- 00 0 - q
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
e
CONSTRUCTION INFORMATION:
0
Lot No.
Block No.
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
_
tectric _ Plumbing _ Sprinklers —Generator _ Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor;
Cost of Construction: $ 4 U!> v-
d _ Utilities: —Sewer _Septic Building Height:
Pitch
—T
OWNERAESSEE: CONTRACTOR:
Name 6'e hi,,avrc Name:3ohnLaw
Address: 37 37 7& "'` kr S w company:
Laws Electrical Service Inc.
City; a 4 "n C t � Lr State: MP Address:5158 NW Primm St
Zip Code: i l 'l 3 JS` Fax: City; Pt St Lucie State: FI
Phone No. S�9 3p- Zip Code! 34983 Fax:
E-Mail: Phone No 772 370 4357
Fill In fee simple Title Holder on next page (if different E-Mailjohnlaw51586801-com
from the Owner listed above) State or County License EC 13006370 29432
If value of construction Is $2S00 or more, a RECORDED Notice of Commencemeni is requnva.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
If value of construction Is $2S00 or more, a RECORDED Notice of Commencemeni is requnva.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION
LIEN LAW INFORMATION:
DESIGNE NGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone
_
State:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Address:
_Not Applicable
Address:
City:
City:
Z[p: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worn any w .••- -_
I certify that no work or Installation has commenced prior to the issuance of a permit.
St. Lade County make rrepresentation that 1s granting a permit V11 out7horize the permit holder to build the subject structure
structure.is in Please consult withpyolur HomeOwnersOwners Associatiome Owners n Association Your deed foror an any restrictions nants that which may applyh. ibit 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-resldentisi 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
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this A t_ day of 'r4 L'% . 20 —A-by
Name of person m king statement
Personally Known OR Produced identification
Type of identification
Produced
of Notary Public -
Commission No. I-T C"T ';
REVIEWS
Rev. 8/2/17
FRONT I ZONING
COUNTER REVIEW
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
thisitt day of 20R'"y
Name of person Taking statement
Personally Known OR Produced Identification
Type of Identification
Produced
Notary Public- State
fiACH
EL coj�MELDAMS
IS$) I i l No.
EXPIRES Janu 5.2019
SUPERVISOR PLANS I VEGETATION
REVIEW REVIEW REVIEW
RACHEL M
MY COMMISSION