HomeMy WebLinkAbout486 holiday out permit.pdfti
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. 3//�i/ Permit Number:
Building Permit Application
Planning and Development Services
Building and Cod,- Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xxxxXx °r
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax I D #: �iS/ / S U O - O G 7. Z - 000 - z _ Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Addrtionai work to be performed under this permit -check all that apply:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_ Gas Piping
—Sprinklers
Block No.
_Shutters —Windows/Doors
Generator _Roof Pitch
Sp. Ft. of First Floor:
Utilities: _ Sewer — Septic Building Height: -
OWNER/LESSEE:
CONTRACTOR:
Name: John Law
Address:Jy 9-q L q he Sa lam. +� YJ rZ
Uompany:uau's Electrical Service Inc. I
City: So—� State: F/
Address:5158 NW Primm St
Zip Code: 7 3 S 7 d Fax:
City: Pt St Lucie State: FI
Phone No. 2 2 A 9 9 2 A
Zip Code: 34983 Fax:
E-Mail:
vhone No 772 370 4357
Fill In fee simple Title Holder an next page (if different
E-Maillohniaw5158QaoLcom
State or County License EC 13006370 29432
from the Owner listed above)
If value of Construction Is $2500 or more, a RECORDED Notice or Commencement a cyv,.=..•
if value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
_ Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as molcatea.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con lct with any applicable Home Owners Association rules, bylaws or and 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
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Signat of Owner/ Lessee/Contractor as Agent for Owner
YU
Signature of ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA.
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 144 day of YY+ Ara 4„ 20,&_by
this I'-( day of 01-14--G 1— . 20-2-2_by
Name of person making statement
Name of person king statement
Personally Known ___i,,ZOR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
.{
{Signature of Notary Public -State o
Y..
of Notary Public State of Florida )
RACHEL IV
DAVIS
Commission No. _>� "
I MY COMMISSIO
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EXPIRES Janu
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UY 5, 2019
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COMMISSION #FFfl
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S January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
VEe.c
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17