HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: aI /T Z Permit Number: _
• hl
OR
Building Permit Application
Planning and Development Services
Building and Lode Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34382
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential'
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 3Y 3 /ys Hy' � /'
Property Tax ID #: L/ SO SO / o s 6 G - a U G - -7 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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:
Sq. Ft. of First Floor:
u
Cost of Construction: $ a ovaUtilRles: _Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name, h.�e ke /Onf-/tiM-'*v✓es-
Name: John Law
Address: BAG op «J& five-
Company:LaWsElectricalService Inc.
Address:5158 NW Primm St
City: Pt St Lucie State: Fl
Zip Lode: 983 Fax:
Phone No 772 370 4357
City: -doI sag r 8 J State: ZE/
Zip Code: ?/ (o Fax:
Phone No. /^ Jos-- ??-r- A2S6
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Maillohnlaw5158@aol.com
State or County License EC 13006370 29432
if value of construction is $2S00 or more, a RECORDED Notice or commencement rs rayull"
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN IN
Name:
Address:
City: State:
Zip: Phone
SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
city:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: state:
tate:
Zip: Phone: —
BONDING COMPANY: _Not
Name:
Address:
city,
Zip: Phone:
__- _ .. x indir2tPd_
OWNER/ CONTRACTOR AFFIDVIT: Application Is nereoy mane m ao—!, a P= ,,.. •� - _ -• _... _.._
I certify that no work or installation has commenced prior to the issuance of a permit.
St L�Icie County makes no represe lotion that Is granting a permit will authorize the permit holder to may build the suor bject structure
structure.iPieasecconsulY wyithpyouror an
H€ome Ow erowners
s Association Association your deed for acovenants
y restrictio s which may apply,
such
form the work
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, per
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
,r rurnrAina vnur Notice of Commencement.
as
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _L day of EZJ9 •20- 2bY
Name of person milking statement
Personally Known OR Produced Identification
Type of identification
Produced
of Notary Public- State o
r""ice RACHEL
commission No.`V;-\ tgs_�aIJ) MYCOMM
' _,el EXPIRES
REVIEWS FRONT { I COUNTER REVIIEW � NG SUPERVISOR
Rev.
Signature
STATE OF FLORIDA
COUNTY OF
The for oins instru ytpas acknowledged me
this T day of
Name of person making statement
Personally Known z OR Produced Identification
Type of Identification
Produced
Y bf Notary Public- State of Florida
DAVIS
f0r~ INo +� RACHEL M
ry 5, 2019 € ;.l MY COMMISSION
PLANS I VEGETATION
REVIEW REVIEW