HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number: S I ' 0 03_�
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 xxxxx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED:I:MPROUEMENT LOCATION
Address: 0,
Legal Description:
Property Tax ID#: L/ �G�- �0 1- C> 3l - GO a - Sr Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESMOTION.;OF WORK;
remove existing pedestal. install 150 amp meter combo on 2" strut stand
CONSTRUCTION:INFORMATION
Additional work to be erformed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
RiElectric Plumbing Sprinklers E Generator a Roof
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 1,500.00 UtilitiesSewer OSeptic Building Height:
OWNER/LESSEECONTRACTOR:
_.._
Name I/r- Name: John R Law
Address: L! 9S-s" F,1-►.,-,7r, 1clid rji-o-e� Yew Company: Law's Electrical Service Inc
City: Iry'dS v✓iv'll e- State: n4i Address: 5158 NW Primm St
Zip Code: y 1-f A G, Fax: City: Pt St Lucie State:FL
Phone No. f- CiO GI- S,J (0�( Zip Code: 34983 Fax:
E-Mail: Phone No. 370 4357
Fill in fee simple Title Holder on next page(if different E-Mail: johnlaw5158@aol.com
from the Owner listed above) State or County License: 29432
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN:LAW LNfORMATION
DESIGNER/ENGINEER: _Not Applicable 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
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 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
commencing work or recording our Notice of Commencement.
4 lel� � S
_Signatur of Owner/Lessee/Agent Signature ofractor icerise Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF Sk I'L'c "st" COUNTY OF S- •
The Qrgoing instrument was acknowledgeoefore me The forgoing instrument was acknowledged before me
thi day of Nab , 20 15by this-,4 day of .20 T� by
(Name of person acknowledging) (Name of person acknowledging)
3Q�'�_�' &"� ��tKw
(Signature
of Notary Public-State of Florida) (Sig ture of Notary Public-1ate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
of Florida
�s`�r'�`e`/, LASHAHNA Tate of Florida
2°•PRv nLa°�: Notary PubLASHlic N StateRAM
'•; ;• My Comm.Expires Dec 20,2018 = •'= Y Comm.Expires Dec 20,2018
Revised 07/15/201 =N•" Commission#FF 177249 9r Commission#FF 177249
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,�•'%FP„���a� Bonded through National Notary Assn. Bon through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS