HomeMy WebLinkAboutpermit app for change orderAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I U AD
ROit -`— Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential_
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED
.,
IMPROUEMEiNT
LOCATION:
Address: O L cE
E
r
Property Tax ID#: XQS(6WO5433cC oa Lot No.490
Site Plan Name: Block No. t)c
Project Name:
DETAILED DESCRI,PtTION OF"WORK:% %
Ld t b;Tf it) r L lO cdl 9 JA0 ntALTErk6k rays
t t t
1� IB vicaier alVe -For di
5Y100tr \'kxA*_1t3 $0 he 60 40 C06e �0 dCAWt%AI PCn=AC Akre tinckol"Jec/
New Electrical Meter Second Electrical Meter
CONSTRUCTION
INFORMATION:
.
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
yy
on2 cc) Utilities: -Sewer Building Height:
Cost of Construction: $
_� —Septic
OWNEf AESSEE:
CONTRACTOR: � .
Name k0i} ^,,, UIVtD1 Ae
CY Name: moo &)icNPIy'l�`4l�i
Address: 503 A4e.- L
Company:!( 1Cf''6 E' 1UY'6XA'T!ChnoI0!iejf
City: 4 Co(-}-e ft(Cpt Stater
Addrests::CO2>13 E �O JU�14i q
Zip Code:3c4gW7 Fax:
City:c ec State:_
Phone No.
Zip Code: ?`}Q) I Fax:
E-Mail:
Phone No 3S ';Y3 S( `LOO
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail roc i
State or County License (LWOVI( c
If value of construction is 2500 or more, a RECORDEDNotice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Phone:
BONDING COMPANY: _Not Applicable
Name:_
Address:
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 Count yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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.
Inconsideration 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF I
SWprn
to (or affirmed) and subscribed before me of
Physical Prese ce or Online Notarization
this (D day of 2026 by
Name of person making statement. �1564'ir�t
Personally Known OR Produced Identification
Type of Identification
Produced Notary Public State or Florida
GG 256113
Commission No. �Sta! t � (seal)
Signature of Contractor/License Holder
STATE OF FLORIDA@
COUNTY OF L
w rn to (or affirmed) and subscribed before me of
Physical Pre nce or_Online Notarization
this day of 202by s� t
cv&C
Name of person making statement .(YW6, /j i AW
Personally Known OR Produced Identification
Tvne of Identification
(Signature of Notary Public -
Commission
notary Pudic Stele d Florid
Samantha Lynn Gates
roeion HH 032552
oentuzoza
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