HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE I Fo MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T ?`Z Permit Number:
'J 71
_
ffam
ffi, 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) 462-1579 Commercial Residential 700000°a
{ PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: l 14, tAle /Wes {y ✓I
Property Tax ID #: ! / TS P, - Se) / - G -e - 0 G 0 l Lot No.
Site Plan Name:
Project
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Block No.
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _Shutters -Windows/Doors
Eectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 9 06 U v
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 4 /t Ra Avnue :e Lie rz o e I
Address: 9.E6 9 ra /0 11 de4- 4K
City: 1,90-1,ki 12r m�f L Stater
Zip Code: 33 y? 6 Fax:
Phone No. r'- $-� /- 3 U S2 - gC) 5//
Name: John Law
Company:Law's Electrical Service Inc.
Address:5158 NW Primm St
City: Pt St Lucie State:—
Zip Code: 34983 Fax:
Phone No 772 370 4357
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MaiUohniaw51589aol.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 $7,00 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION UEN LAW INi ORMATION:
d
DESIGNER GINEER:
Name.,
_Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
State:
_Not Applicable
Address: -
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
Installation as indicated
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work an
I certify that no work or installation has commenced prior to the Issuance of a permit.
St. Lyde Count makes no representation that is granting a permit will out arize the permit holder to build the subject structure
which 1s in can Ict with any applicable Home Owners Association rules, aws 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 apply.
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-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
Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this J_ day of IC'r b, 20-22bY
Name of person m king statement
Personally Known OR Produced Identification
Type of identification
Produced
(Signature of Notary Public- State
Commission No. V , t`^,
REVIEWS
Rev. 8/2/17
FRONT I ZONING
COUNTER REVIEW
STATE OF FLORIDA
COUNTY OF
The for oing instrunprIt yeas acknowledged before me
this day off 6 Zdby
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
produced
RACHEL iJ DAVIS J
MY COMMiSS10 �jNo.
E:fPIRES Jams ry 5. 20Y 5
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW I REVIEW
RACHEL M
MY COMMISSION