HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Aa s--A 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 )0000000'
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
f0
7,1 C"
S' CSC e.r0vr
19.e- 4.1. s a' b
Property Tax ID #:
41 S // -
SU.1 -
00 S k -
00 0 - 3 Lot No.
Site Plan Name:
Project Name:
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
Li6ectric _ Plumbing _ Sprinklers _ Generator —Roof Pitch
Total Sq. Ft of Construction:
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Cost of Construction: $ A 00 o
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nameuc 4, d 54 ,atv� C f.Ak�
Address: ho f3r 4 ior/os-
Name:dohn Law
Company:Laws Electrical Servicelnc.
Address:5158 NW Primm St
A
State: %
city: != k"y&-,'c_t2 e t L
Zip Code: ! l i W 1,j Fax:
Phone No.
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-Mail lohniaw5158@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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER NGINEER:
Name:
Address:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_,Not Applicable
Address:
Address:
City:
Zip: Phone:
City:
Zip: Phone:
1. --J !-KnitatiNb'�C IRlnlf]tP({
OWNER( CONTRACTOR AFFIDVIT, Application is hereby made to ootam a permR io ou ul=
I certify that no work or installation has commenced prior to the issuance of a permit.
any
may
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. Lurie 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
as Agent
STATE OF FLORIDA
COUNTY OF
The forgoing.nstrum�gt acknowledged before me
thls day of !` s 20 i 2by
Name of person mjiking statement
Personally Known FOR Produced identification
Type of Identification
Produced
STATE OF FLORIDA
COUNTY OF
The forgoing instru nt was acknowledged before me
this2l day of 7r S 2022bY
Name of person making statement
Personally Known OR Produced Identification
Type of identification
Produced
L
bf Notary Public state of Florida I
j
(signature of IN Public- State o
RACHELN
DAVIS
Commission No.' l -
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MY COMMISSIO
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EXPIRESjanuary5.2019
?•f MY COMMISSION #FF1
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