HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 mom
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: /(-" %0 !- S - GC r — r)Y-L 4L k62 -
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Hack:
Right Side: Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
remove existing pedestal install new 150 amp meter combo pack on 2" alum strut stand
CONSTRUCTION INFORMATION:
Additional work to e e Orme t un er is permit -check a appy:
0HVAC� Gas Tank E]Gas Piping _ Shutters Windows/Doors
VElectric El Plumbing O Sprinklers E] Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ (_(P G c> Utilities: _Sewer 11 Septic Building Height-
OWNER/LESSEE:
eight:
OWNER/LESSEE:
CONTRACTOR:
Name
Address; d ,G..,,14 S f
Name: John R Law
Company: Law's Electrical Service Inc
City: 1, State: f
Zip Code: V C�; LY / 7 Fax:
Phone No. l - f 7 b 7
Address: 5158 NW Primm St
City: PT ST 'Lucie State: FL
Zip Code: 34983 Fax:
Phone No. 772 370 4357
E -Mail: johnlaw5158@aol.com
E -Mail:
Fill in fee simple Title Holder on next page (if different
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 LAWINFGIRMATION;
DESIGNER/ENGINEER: Not
Name: _
Address:
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip= Phone: T'
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
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 Horne 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 pians, 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_
_ SignaturFFLORIDA
Owner/ Lessee/Agent
STATE
COUNTY OF
The foygoing instru was ackn wledge efore me
this I day of 20 �by
gone, iia /n�6 c%
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Ide
ANNE BROWN WALMACH
MY COMMISSION 4(4494663
EXPIRES April 21. 2020
Revised 07/15/2014
REVIEWS I
EI RISUPERVISOR
COUNTER REVIEW I
COMPLETE
INITIALS
s
Signature Contractor/License Holder
STATE OF FLORIDA
COUNTY OF SC J L ✓ c.. L
The for oinginst ent was a cnowl d e� before me
this day
of t� by
A )I )a I --
c,
(Name person acknowledging)
:�4 , U=dwc �
(Signature of NotaryPublic-Public- State of Florida)
P
Personally Known Y OR Produced Identification
Type of Identification Produced
Commission No..•`v"' ANN0B ,ryN WALMACH
9 ,7j%.,% MY COMMISSION N FF9U663
REPLANV W VREVIEWON 5EA EVI�EWLE M EVIEWVE