HomeMy WebLinkAbout35 holiday out permit.pdfti
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 2 Z Permit Number:
4 �
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, . 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: IO 7 o`L 1F S OGT/hv, {l✓✓C S -3
Property Tax ID #: , rT x-// S-o /- G O 19 - G U 0 " -7
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
CONSTRL)CTION INFORMATION:
Additional work to be performed under this permit- check at) that apply:
_Mechanical _ Gas Tank _ Gas Piping —Shutters -windows/Doors
Electric _Plumbing _Sprinklers Generator —Roof Pitch
Total Sq. Ft of Construction: r/ Sq. Ft, of First Floor:
G
Cost of Construction: $ sa2 Gy Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 0'4"-./ i r ^at / k
Name:John Law
Address: 19 W.r N AiNN G l fZ
Company!Lmx s Electrical Service inc.
City: i� 1,a .'r f u �y State: Nl�
Address: 5158 NW Primm St
Zip Code: U? 9'&r Fax:
City: Pt St Lucie State:F1
PhoneNo._�� %D3, gl g' �! c%.L
Zip Code:34983 Fax:
Phone No 772 370 4357
E-Mail:
1 E-Mail)ohniaw5158@a6.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License EC 13006370 29432
If value of construction is $2500 or more, a RECORDED Notice of commencement ra r ayrn a ..
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
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as inoicateo.
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 conflict with any applicable Home Owners Association rules, bylaws or andcovenants 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
.nrL nr rnrn n-lina vnnr NnfirA of rnmmpnrPmPnt_
Signat of Owner/ Lessee/Contractor as Agent for Owner
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 ILI day of 20,g2_by
this jam- day of 1-+ . 202Zby
Name of person milking statement
Name of person king statement
r OR
Personally Known T/ OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Vj
jSignatureoff,Notary Public- State o
f Notary Public- State of Florida I
RACHELN
DAVIS
Commission NO. 4
!a MY COMMISSIO
CrP
No
RACHEL M DA
^m'r�,,,�@ EXPIRES Janu
try 5, 2019
(aDrI 3J8-0153 Floridallotary
mice.cnm
MY COMMISSION #FF7
°'1•. / i
S January 5,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
QVEe.c
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17