HomeMy WebLinkAboutwhitelock permitALL 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end oT line
PROPOSEb iMPRQVEMENTLOCATION..
Address- 3aq
tjW MA
Legal Description:
Property Tax ID
Lot No._
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OFMORK-
REPLACE 0-00 Amp /k) JElZIOP, L10 C/ZO17-
MET-EK CA �J A Nt) VJ I RE
CONSTRUCT, IM INFORMATION'
Additional work to Up nerformea under thiip6rRt--EFFeEK all app Y:
OHVAC []Gas Shutters
Windows/Doors
Gas Tank Piping
EElectric Plumbing OSprinklers Generator
Roof Roof pitch
Total Sq� Ft of Construction: S' Ft of First Floor:
ElSeptic
Height:
Cost of Construction: CC) (11 Utilities: Sewer Building
OWNER/ILESSEE�.
Name 9 l'TF_ L-0c
Address: 11Y;Lq AJ�J pw_
City: FA CJY State: rL.
Zip Code: '3"9 6- Fax:
PhoneNo. 7-2a— 976
.:-79171
E-Mail-
Fil I in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: ARTHUR ENGELMANN
rrimminv- ACCURATE ELECTRICAL CONTRACTING, INC
Address: 7193 GULLOTTI PLACE
City: PORT ST. LUCIE State: FL
Tip Code: 34952 Fax:
Ph,,n,, Nn_ 772-878-9171
E-Mail: ACCURATEELEGTRICPSLgOUTLOOK.COM
State or County License: ECOOD3072
if value of constru )n Is �200 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIOR UENIAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name; ARTHUR ENGELMANN
Address:
City: State:
Zip: Phone
City: MRTSTA-LICIF State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER. Not Applicable
Name:
Address:7193 r-ULLUTfl PLACE
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phonic:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to 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 CountV 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 Wst inspection. If you intend to obtain financing, consult with lender or an attorney before
commencV* work or rewrdiniz vour Notice of Commencement- /*) —
re of
as Agent for Owner I Signature of
STATE OF FLOWDA STATE OFFLAIDA�
11�-220 COUNTY OF
COUNTY OF
The fuTWing Jnstruq�ept was ac�powledgecl before me
this/4dayof 200 by
Name of person making
statement
Personally Known
OR Produced identification
Type of Identification
Produced
(Signature of Notary Pubtk4�4WI##1 Florida)
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REVIEWS
DATE
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Rev. 31Z/17
The forgoing instrurr)ert� was a'�knciwledged before me
this J 4day of d' 20_�? by
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Name of personMaking statement
Personally Known_—�� OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pu ollilij"#f Florida
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