HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MU57 BE COMPLETED`FOR APPLICAflON TO BE:AGCEP7 ED
_ . Permit[Number:.VO
RECElV7D JUL 12 201B
e
Building •Kermit Appl pt ,on
Pldphing and:Development-Services
Building tihd."Code,RegulafiorvD►vis oh
2300_V1rgiriia_Avenue,Fort;PierceFl34982
Phone:(772)4s2-1553 Fax:(,7,72).451-1ST$ Commercial: Residential'
PERMIT APPLICATION FOR To Select from dr;o--', click arrow,at the end.of line
�PRQf?OSEDtMPRfJ1lE(VjENTsLOCATION ,..; _. .>'..... ., c:-v�� -
Address: IV:`7. 5 .f.•. oC'��h' �.�.. �'.- 3�'
Legal Description:
Q 0'"11 C� :Lot No.
Site Plan Name: Block Now.
Project Name
Setbacks Front. Back: RightSide Left Side;
DETAILED{DESCRIPTION OF WORK:
,remove:existing pedestal install neer 150 amp l titer combo podk:,on 2"alum strut stand
CONSTRUCTIONINFORM "TIO.N
_ .
Add
itiona ,wor toe e orme , un er ,►s perm —c ec all
; appy r
C�HVAC f .Gas Tank E]Gas Piping _Shutters Q Windows/boors
.Electric 'MPlumbing, 1p'rinklers; ❑Ger eratoc Roof
Total Sq.Ft of Construction;,,., S'..'Ft.of Fir' floor:
C st of.ConstrucHon:' - / °wGcJ" Utilities: "_Sewer
o $ QSeptie Buildng;Height;
OWNERJLESSEE> _
CONTRACTOR:
i. ter'. Q h.a John R Law;
Name:_ C1' F .L 1i' (� HT_ f-J �� Name..
Address: S`�` YS 1 ri.�:l-4ia:vrn. �'Ytis Com an ..Law's`Elecfrical;S.eryice Inc
Company:,
y:
Ci _ o/*y iy''4'' State: Address:
ty" � v sM�.• 5158 NUV Primrn St
-
Zip Code C_,i't cJ Eaxc City:.F'T Lucie,
State:FL.
Phone No. 1 7:X. �f �.;� �.y. 34983
`'1 �I Zip Code:,
E=NEail: Phone q
-7-7237043 57`
Fill:in'fee simpl%Mtle Holder on'nekt page'(;if different E-Mail: john1aw5 f58@aol com
from the Q*ner listed abovef .State or county License:
If value of construction is$2500 or more,a RECORDED Notice;of Coi r ence►rient isre9 cored:
3 �
$UPPLEME`NT�LFCONSTftUCTiON'LIEN LAWtNFOf�MA�ION x i z x '" 53 x 4 1
•.m .., n.�rr- ,..E. ,c,' <w,.z.-r. .;.� . ,.a-. ! . .r_..:...... �.. „ . z .a.,1 H :.: 4..ti est; _._ ,...�.,-,., t.:. ar_...,.<> ,. 'S'
DESIGNER/ENGINEERc _Not Applicable MORTGAGE:COMPANY _Not Applicable
Name:- Name:
Address: Address:.. .
G#y: State: City:, State . ..
Zip: _ —,Phone':,, Zip: Phone-., .,.
FEESIMPLE TITLE HOLDER,;; _Not Applicable BONDING COMPANY' Not.Applicable
Name: -Name:.
Address: Address:
City: City:
ZiP' Phone;;
Zip:. . . .Phoney.,
l'certify:that_no_Work:oe installation has-commenced prior to the,issuance of a permit.
St Lucie countv makes no representation that is granting-a permit will:authorize`the'per'mit holder to build the subject structure.
which is in conflict with any applicable Home Owners Association bylaws or and co"venant"s°that may.estrict or prohibit such
structure.Please consultWth 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.t ereby agree that I Will,in all respects,perform the work
in,accordance with,the approvedplans,:the Florida Building Codes and Sty Lucie County Amendments:
The following building permit applications are exempt from undergoing a`fu11 concurrency rev�ewi,room additions,
accessory structures,swimming pools;fences,walls,signs;screen rooms-and accessory.uses to another non residential use,
WARNING TO,CONM Yourfailure to Record a Notice"of Commencement may resultin your paying twice for
improvements-to-your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection..af you intend to obtain financing,'consult!uvith lender-or-an attorney.before
commencin work or recording our Notice of Commencement.
.
/4- - s
signature Owner/Lessee/Agent; Signature ox-ontractorlpceni6 Holder
STATE OF FLO� STATE OF.FLORI
C6UNTy OF. � C/ _ COUNTY OF' .1f:/L;lJc
The for ping iristic"' as acknpiniledged before The:for ping instrumen was acknowledged before me`
this L day of 20.4. y this day of 20 by `
t f + , tj
(Name of-person acknowledging-) (Na of"personacknowledging)
kJdh(Signature of Notary Public=state of Florida} (Sigpa,ure of Notary Public=$tate of F arida}
Personally Known �1. bil'Produced-ldentfication Personally"Known ORLProducedIdentification
Type of Identificatiori Produced Type of Identification:Produced
/ l, ( e .M
Commission No. ROWN WAL dACH.
A1104E MWWN
WALMAR�fj:, OMMISSION.#FF88Ae83'
FiiekkES April 21 A020
_ 407 398-0163. - ROitdeNa4�Y34wtt�
Revised 07/15/2614 21 i 2020
REVIEWS FRONT ZONING SUP.ERVISOR PLANS. VEGETATION SEA`TURTLE MANGROVE`
COUNTER REVIEW REVIEW REVIEW REVIEW 'REVIEW
REVIEW`
DATE
COMPLETE
INITIALS