HomeMy WebLinkAboutWhite PermitAll APPLICABLE INFO BE COMPLETED FOR APPLICATION TO BE ACCEPTED
MUST
Dater: 1Z Permit Number:
12S
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential /X\
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: p _ r
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PROPOSED IMPROVEMENT COCATIRGN-` '
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Address: 40 H
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PropertyTaxlD#: 3LIlJ�- �- clJt[J- Q - Lot No. ( G+17
Site Plan Name: Block No. �.
Project Name:
DETAILED DESCRIPTION -OF WORK.
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New Electrical Meter Second Electrical Meter (Affidavit required) '-O
CU"UCTION INFOWATIOPI:
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 X, Roof -5 12 Pitch
Total Sq. Ft of Construction:'5 (o O d Sq. Ft. of First Floor: 5 (O O O
Cost of Construction: $ SI 5GO Utilities: _Sewer -Septic Building Height: 1-51
Name V 1( YJ
Name: e F f f �1 C f r O
Addres � H0 -eCt � (`E&-
Company:j fOGF11'\y "- (Pfxt1Y�►1
City: } �� Stater L
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Address: qQH 51r 1 Si -
Zip Code:5-2 Fax:
City: IPAA Vti c L y State:
Phone No. E-
Zip Code: SRC( �i C Fax:
Mail:
Phone No _%% Z Z - I C-(
Fill in fee simple Title Holder on next page (if different
E-Mail 00 C4"1kE fg L wi pl\!�
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/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:
City:
City:
Zip: Phone:
Zip: Phone:
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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with an applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 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 attorney before commencing work or recording vour Notice of Commencement.
Sign o 06np Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
L CACI{
COUNTY OF
Sworn to (or affirmed) and subscribed before me of X
Physical Presence or Online Notarization
this L�L_ day of OC}60—e V , 20 21 by
_
Name of person making statement.
Personally Known Y_ OR Produced Identification
Type of Identification Produced
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1 � _ � n
V 1 �xn-
Ptt
(Signature of Notary of FI ida)
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Commission No. 10(o1gf42 Seal) t NANCY HAG�ERHpRST
_
Notary Public
— State of Fl rlda
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? CommM HH167992
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Wres 8/23/2025
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