HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4
Permit Number:
t J'
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 xxxrcooa
PERMIT TYPE:
I PROPOSED IMPROVEMENT LOCATION: I
Address:
J
Property Tax ID #: C-/So �- % / - D % 6 3 - CJ p G - 7 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
:J
Block No.
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
,Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
o.-
Cost of Construction: $ 02 G Gu Utilities: —Sewer —Septic
Windows/Doors
_ Roof
Building Height:
Pitch
OWNERAESSEE:
CONTRACTOR:
Name C o & Lv i , f
Name -John Law
Company: Laws Electrical Service Inc.
Address: (0 6 t/ C' l 3 i,+ t
City: Jwa fir' lov'..! State: Mr
Zip Code: Fax:
Phone No. /' °t,_7f F%"JFS6
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Address:5158 NW Primm St
City: Pt St Lucie State: FI
Zip Code:34983 Fax:
Phone No 772 370 4357
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFOR?0ATION:
Name: — -- -
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone.
MORTGAGE COMPANY:
` Not Applicable
Name:
Address:
City:
State:
Zip: Phone:
BONDING COMPANY:
_Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Coup makes no representation that Is granting a permit Mil auvTorize the permit holder to build the subject sWIV a
which is in conflict with any applicable Nome Owners Association rues, bylaws or antl covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may appfy.
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respecis, 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, wails, 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 lender or an attorney before
commencinit.work or recording Your Notice of Commencement. _
SlgnatuA of Owner/ Lessee/Contractor as Agent for Owner
Signature of ntractor/Lfcense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this A t day of 'r4 &. 20AA--by
this R t day of 7;a — 20 .9,Lby
Name of person making statement
Name of person raking statement
f
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
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(Signature of Notary Public State—. or
bf Notary Public- State of Florida)
RACHEL
DAMS
Commission Na. ' s 1 ': =';
f+' al)} MY COMMISSI
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No.. t
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EXPIRES Jams
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(4M 3980153 FloritlzNcda
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January 5.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
ifEe
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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Rev, 8/2117