HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
V4 ,
• RECEIV7D OCT 10 7015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginfa Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 . Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end-of line
PROPOSED IMPROVEMENT LOCATION:
/
Address: �D
Legal Description:
Property Tax ID#: 42d4..51- Odd —D Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toflasTank
orme undert is permit—check a appy:
AC []Gas Piping _Shutters Windows/Doors
Electric E-1 Plumbing OSprinkiers E]Generator ❑RoofRoof r itch
O P
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ DTA, !fie Utilities Ft
ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name /7— v L-/ C Name: .lames W Law
Address- #o?7l� Company: Law's Electric,Inc.
State: Address: 218 Beach Avenue
Zip Code: 3,314,6 Fax: City: Port St. Lucie State: FL
Phone No. Zip Code: 34952 Fax: 772-878-3347
E-Mail: Phone No. 772-971-4512
Fill in fee simple Title Holder on next page(if different E-Mail: lawselectricinc@aol.com
from the Owner listed above) State or County license: ER0000122
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
6-d -892 6-199-199 LtiE88L8ZLLMd� ez-V O L 9L U 100
SUPPLEMENTAL CONSTRUCTION LIEN LAVA INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: t-1 Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: rrNot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 a permit will authorize theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or andcovenantsthat 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 exemptfrom 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.
L45—W
Sign re of Owner/Agent/Lessee Virtature of contractorlucense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OE � 1.� COUNTY OFl,,tZ-ot�i
The for oing instru nt u as acknowledged_before me The for oing instrument was acknowledged before me
this day of 20,^�by this day of ggzz oe A) ,20_eAby
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (5i ur of Notary Public-State of Florida)
Personally Known ✓ OR Produced lden . tion A Personally Known I/ OR Produce N T, p LAW
SIC
Type of Identification Produced NOZARY P ILJ of identification Produced
—
99,4,1111L -OF FLOR!
STATE OF RID ltssion No. ��"A 4aWlExplresl=WO
Comm#EE846906
Commission No. E ��{�Qa 6 ( � Comm#EE
Expires 10 812016
Revised 07/1512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU RTL£ MANGROVE
COUNTER REVIEW REVIEW REVIEW. REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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