HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /'�'
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Date: � r j,b Permit Number: R,01 - V v
37,
RECEIVED
Building Permit Application JAN 1 5 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential Yxo=
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �L-
:PROPOSED"IMPROVEMENT LOCATION =
Address:
Legal Description:
Property Tax I D#: Hs-0;L - SO 1 - 01 9S,_ O G -'z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION;.yOF WORK k;
remove existing pedest1al.
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CONSTRUCTION INFORMATION ,i 4
AdClitional work toe performed under this permit-check a appy:
HVAC II Gas Tank ❑Gas Piping Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers [:]Generator Roof
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 1,500.00 Utilities:ll Sewer Septic Building Height:
OWNER/LESSEE "< CONTRACTOR
Name 6, d- t 4--A Q 'Tc)Y7 r Name John R Law
Address: �L_ hiti NI zs n I v•/ Company: Law's Electrical Service Inc
City: A-fos ch 93r4c,1, State:0 Address: 5158 NW Primm St
Zip Code: 3 Lt 7 Fax: City: Pt St Lucie State:FL
Phone No. f- 5 S`-1- SZip 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
It value of construction Is$1300 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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.
S
_
Signatu re/01 Owner/Les .e/Agent Sign a of Contractor/Lice se Holder
STATE OF FLORIDA STATE OF FLORIDA 1 -
COUNTY OF COUNTY OF I JU 1
The forgoing instr Tent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 LS:-by this day of 20 by
Ln yo �I IBJ' ULA
(NaniJ of per-so knowledging) (Name4f person ac Qowledging)
o_
(Signature of Notary Public-Stale of Florida) (Signature of Notary Public-State of Florida)
Personally Known N/ OR Produced Identification Personally Known t-/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
`" "• S. NIELSEN
Commission No. ,�.Fa`°`B'�,- � ommission No. S. N I E LS E N
Comma sio;1 N FF 115637
�� Pr My Commission Expires Commission k FF 115637
oa a%
8N My Commission Expires
. June 12, 2018
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Revised 07/15/2014
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