HomeMy WebLinkAboutBuilding Permit ApplicationDESIGNER/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--
ddress:City:
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 your Notice of Commencement.
_ Signatur Owner/ Lessee/Agent
STATE OF FLORI
COUNTY OF�
The forgoing instrument was acknowledged before me
this .2 day of n 20 .jkby
(Na of person acknowledging)
rl
(Si nature of Notary Public State �of F orida }
Personally Known \�- OR Produced Identification _
Type of Identification Produced
Commission No. /"- F7 7C y6i -3 (Seal)
:' ;: ANNE B
ROWN WALMACH
Revised 13? IS 1 : MyCOMMISSION !1 FF9g4683
1°!7) 153 Lb.rlt 21, 2 20
REVIEWS 'FRONT SUP RViSOR
COUNTER REVIEW iEW
DATE
COMPLETE
INITIALS
Signature of Co,pfractor/License Holder
STATE OF FLORID ! / o
COUNTY OF F / vc I 'e
The forgoing instrument was acknowledged before me
this ;2_1 day of V-ec /20 / E�by
)In P'816 Iun I x �CcJf�1�C
(Nam�of person acknowledging)
��.�&014m l Id.,
�.
(Signature of Notary Public- State of Florida)
Personally Known_ OR Produced Identification
Type of identification Produced
Commission No. (Seal)
T ;aA ')TC I'.";; ANNE BROWN we, ...e
, My COMMISSION # FF984663
I„
Via;, EXPIRES April 21, 2020
(407)39&0153
FjL4iw___
"".Cm
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW I REVIEW
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE A,- xri cu
Date: J► � � �
Permit Number:
16A
� 1 -#
M MOT
.1111 �J1 16jIL1,111I11114,11,611 N 00I1a1111AP, Building
■■ Permit Application
Planning and Development Services
Building and Code Regulation Division
23W Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-2578 Commercial Residential, x«
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line -
PROPOSED IMPROVEMENT LOCATION: ,
Address: % U
Legal Description:
Property Tax ID #: S / i -
Site Plan Name:
tot No.
Project Name:
Stock No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:...
`fie lvcL t
4 7 � o*— vt i it t jV r z. r Su 4 /9
G r� n r 4� v F He./
CONSTRUCTION INFORMATION
Additional work to be nerrormen unser this permit- check an t= apply:
HVAC i =1 Gas Tank F]Gas Piping Shutters
Cj Windows/Doors
Z Electric FlPlumbing Sprinklers Generator ❑_ Roof
Total Sq. Ft of Construction: S . Ft. of First
j'Floor:
Cost of Construction: $ %c (/�J G✓ Utilities:llSewer L_i Septic Building Height:
OWNER/LESSEE.
CONTRACTOR:
.N
ar'' �
me d-,� /'(//�
Name: John R Law
Address: `%'-/ /� /2 U � h -f s f -r-
Company: Law's Electrical Service Inc
City: P .14 V14 n kn v i% + C, tl 4,q � State: P,&
Address: 5958 NW Primm St
Zip Code: �-t 17 T U Fax:
City.' PT ST Lucie State.. FL
Phone No.
Zip Code: 34983 Fax:
E -Mail:
Phone No. 772 370 4357
Fill in fee simple Title Holder on next page (if different
E -Mail: johniaw5958@aol.com
from the owner listed above)
State or County License: 29432
if value of construction is $25011 or more, a RECORDED Notice of
Commencement
is required.