HomeMy WebLinkAboutBUIIDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .2�J, Permit Number:
y 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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: /0 7 .2 S S. O/•-o/l h J%L # .L3 u
Property Tax ID #: y' S// S-U J— G ! 6 S — C� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ _q e--) Clcr `
_ Gas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name PcJr- d l3otiwrG /JE Ivy tf
Name:John Law
Company:Law's Electrical Service Inc.
Address;5158 NW Primm St
Address: YCU 2 c.? 101'- c wa !4 PIL
Ha State: L/G
City: ��.ji ,
Zip Code: sZ 7 ? `-i 9 Fax:
City: Pt St Lucie State:—
Phone No. %' ? 7a- %Z 9 - a 9 2 L
Zip Code: 34983 Fax:
No 772 370 4357
E-Mail:
Phone
Fill in fee simple Title Holder on next page (if different
E-Maiilohnlaw5158@aol.com
State or County License EC 13006370 29432
from the Owner listed above)
if value of construction Is $2500 or more, a RECUHoeu nonce or M;U., ��•
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION
UEN LAW INFORMATION:
DESIGNER NGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone
State:
Address:
City.
ZIP: Phone:
State:
FEE SIMPLE TIRE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_ Not Applicable
Address:
City:
Address:
City:
Zip: Phone:
__J 1-.f..tl�finn 7t ihAiro?Pf�
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to ao dic w�, R •... .........
I certify that no work or installation has commenced prior to the issuance of a permit.
St Lucie Counttyy makes no repr t tion that Is granting a ermit will authorize the permit holder to build the subject structure
which Is in conflict with any pike e e Owners erAssociationAssocandrules, b review your deed or atny resttiiitionsawhithtmay applyhiblt such
structure. Please consult w h your
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 of Commencemen
.
Signature of ntractor/License Holder
Slgnat of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE Of FLORIDA
COUNTY OF
COUNTY OF
The for oing instrumggt was acknowledged before me
S 20 s�Zhy
The forgoing instrum t was acknowledged before me
this.0 day of P SS ze2_�Y
this day of tl-e
Name of person making statement
Name of person making statement
Personally Known � OR Produced Identification
Personally Known OR Produced identification
_�
Type of identification
Type of identification
Produced
Produced
bf Notary Public- State of Florida j
(Signature of No Public. Stateo
}",,,,'//'�� RACHEL
DAVIS
No ' ' '"'�
1�'�
Commission No. ! .:.-'• i`•r' MY COMMISSSiO
%
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RACHEL M DA
EXPIRES Janu
5, 2Q58 t#.' `•_I pay COMMISSION aFF1
IaoTj 3BBd753 FiwidatintEry$ar•ice.eam
ES Janue 5,
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION WE`
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
I COMPLETED
Rev. 8/2/1:7