HomeMy WebLinkAbout485 holiday out permit.pdfti
All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO Is BE ACCEPTED
Date: Z 'L_ Permit Number:
I Now
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION: —i
Address: /0 7.2 S Y. U c-t a-,, f')-tL -A
Property Tax ID #: y .i / ( - S'U 9 - D O ;21 Y - O 06T - R Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check ah that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
Eiectrie _Plumbing _Sprinklers _Generator —Root Pitch
Total Sq. Ft of Construction: _ Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: /
CONTRACTOR:
Name (a, -Tye H2, (,a. A3.4_rI
Name: John Law
company:Law's Electrical Service Inc.
Address:5158 NW Pnmm St
Address: C 7a 7 S w
city: P 10'3, C'4 4 State: l
Zip Code: 6 3 6f R !J Fax:
Phone No. 7 ?a- A g PL`3 ';;k b
E-Mail:
City; Pt St Lucie State: FI
Zip Code: 34983 Fax:
Phone No 772 370 4357
Fill In fee simple Title Holder on next page I if different
from the Owner listed above)
E-Mail l0hnlaw515B@aoi.com
State or County License EC 13006370 29432
if value of construction Is $2500 or more, a RecoRDEo Notice of commencemeni ,s reyilfe—
if value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
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 inoicateu.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conFlict with any applicable Home Owners Association rules, bylaws or andcovenantsthat 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,
accessorystructures, 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
...0 r. ..,,lino „nor Nlnti,m of rnMmonrampnt
Signat of Owner/ Lessee/Contractor as Agent for Owner
Ve
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 1q day of
this LY day of In . 20?,_-j_by
Name of person statement
Name of person king statement
/making
Personally Known OR Produced Identification
Personally Known R Produced Identification
---tom
Type of Identification
Type of Identification
Produced
Produced
iSggnature of Notary Public- State o
of Notary Public-�Sftate of Florida )
RACHELN
DAVIS
r
Commission No c '- .
:a) MY coMMiSSIO
Et 4sw a;'
1(4071WEI-01M
g " ° +` RACHEL M DA
EXPIRES Janu
ry 5, 2019
Floridallotary
mce.com
Y� MY COMMISSION #FFi
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•
1 S January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
�dEe.c
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17