HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: eZ LLIAZ Permit Number: _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34582
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xxxr0000c
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: /U 7 AS S 0
it j
✓✓2 Aqtr
%Z-2 5 --
Property Tax ID #: �/ c- / / "
S-� /
6 / &.2 -
O G C, 0-- 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
t = Electric
_ Plumbing
_ Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ '20VLJ v
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Address /i 77S S• U[r�Ya ✓!tL s`L.5
Name:John Law
Company: Law's Electrical Service Inc.
Address:5158 NW Primm St
City: Pt St Lucie State: Fl
Zip Code: 34983 Fax:
Phone No 772 370 4357
City: -Tc h s C" Y.74 n?e L State: t�
Zip Code: ?f-/% S7 Fax:
Phone No. Z7 2 - %zG(- SO gs
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
E-Mail)ohnlaw5158080l.com
State or County License EC 13006370 29432
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is regwrea.
if value of HVAC is $7,S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
State:
City:
State:
City:
Zip: Phone
Zlp: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
city.I
Address:
City:
a Zip: Phone:
Zip Phone:
tl t n as indicated
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and in a to
I certify that no work or installation has commenced prior to the Issuance of a permit.
5t. Lcu�de Counttyl makes no represent tion that is granting a permit will auytlhaorize the or permit holder to build the subject structure
structure. Please consult wwith ithpyouur Ho a Owne Home ers Associatirs onbandrreview your deed for any restrictnants ions may or apply,
such
in consideration of the granting of this requested permit, I do hereby agree that I will, in ail 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
commencing.work or recording our Notice ar wmmencerrrcru.
Signature o0ontractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrum t was acknowledged before me
e6 20 AXby
The forgoing instrument was acknowledged before me
this day of Fd Gr . Zo� �Zy
' this j � day of
Name of person making statement
Name of person m;iking statement
Personally Known OR Produced Identification
Personally Known OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
Notary Public State of Florida)
State
(Signature of Notary Public o
RACHEL N
DAVIS
``y
Commission No. :- . - ., `, r ; My COMMI9SI
�s . ' f
Janu
13�
ry 5, 26t8
1:1^
"�k;.FIACHEL M DA
as EXPIRES
r ^I MY COMMISSION MFFt
--
lap'r135184153 Flond04014 Sarvice.e3m
n,,;a - S January 5.
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION`
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17