HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 9r��t�Q
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Building Permit Application
Planning Ind DevelopmentServices AUG 1, 7 2016
Building and Cade Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropboz, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address
Legal Description:
Property Tax ID 76 Lot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CEO NSTRUCTION INFORMATION:
Additional WorK toMGasTank
orme un ert is permit- ec a appy:
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HVAC El-as Piping Shutters Windows/Doors
Electric L_I Plumbing �5prinklers Generator EIRoof Roof pitch
Total Sq:Ft of Construction: Sq.Ft.of First Floor-
Cost of Construction:$l / �(7•�0 Utilities:0 Sewer 0—Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: James W Law - '--
Addressr Cgmpany: Law's Electric, Inc.
City: State: Address: 218 Beach Avenue
Zip Code: Fax: City. Port St Lucie State: FL
Phone No.' 7.;7a - �5 76 - 41a-le, Zip Code: 34852 Fax: 772-8783347
E-Mail:� Phone No. 772-971-4512
Fill in fee simple Title Holder on next page(if different E-Mail: lawseiectricinc@aol.com
from the Owner listed above} State or County License: ER0000122
If value of construction is$7500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/I ENG I NEER: _NotApplicabie MORTGAGE coMPANY-
—ZNot Applicable
Name: Name:
Address: I Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: &,--Not Applicable
Name: I Name:
Address: I Address:
City: I City:
Zip: I Phone: Zip: phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permitto do the work and installation as indicated.
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 permitwill authoriaethe permit holderto 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 well,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
commenting work or recordin - Our Notice of Commencement.
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Sjffiature of Owner/Agent/Lessee SWIature of Contractor/license Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �� ..(GF'.t COUNTY OF �� zz ,
The forgoing instrument waa ncknowledged_before me The forgoing instrument was acknowledged before me
this l7 day of 2D�by this_�day of 20_4Lby
(Name of pejson acknowledging) (Name of person acknowledging)
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(Signa u d Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
JULIET LAjFL
AYLIET LAW
Commission No. �5 �4�� NOTARY Pommission No. F�1d�D6 t
STATE OF A TARY PUBLIC
STATE OF FLORIDA
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qM 1 Expires 10128=16Expires 10121312016
Revised 07/25/2014 .
REVIEWS : FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
i7ATE _
COMPLETED
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