HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential
PERMIT APPLICATION FOR: EtOG€n(CY Ale Ctiko&E Our - trt/E Fo(R Lrxt
PROPOSED IMPROVEMENT LOCATION: AEENI;-
Address:
Property Tax ID #: 34 95 '70s -Oom - 0oo' Lot No. 15
Site Plan Name: Block No. Al -
Project Name: STI,VEST-Ck i&S=btAlCE
AILED DESCRIPTION OF WORK:
Tb tJ I y '� EE R TEMPS-169 PAe-4AGG aN-rr
7.ti�W �tATr.2
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additi
Xal 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:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name STU.AP.r SsL-VEsTOt
Name: MAA14 A VT:%lES
Address: 36c1q WESTCNE$TM CT
Company: A7-Tf=L, .IA.C-
City: POPT SATOt LkGLE State:
Zip Code: 5lg5a Fax:
Phone NotW 785 -9939
Address: S �/ T�i .L
n _,A
City:4lilEST AI.M DEM State: FL.
Zip Code: 3'i S Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail .GO
State or County License CA NU 5 3
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 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 attorne before commencin work or recordin our Notice of Commencement.
Signature Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S'r L LA E
Sworn t$$.,��or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
_
this1"tlayofaWLAA& 20;by
�(jn&ll 5TD_V6STM
Name of person making statement.
Pe pally Kno �OR Produced Identification
T pe f Identifi ion Produce
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iWit r war a Pry yb is -Sat of Florida )
State of Florida
ali sPul Whiting
Commission No. 3qq (Sea oilse Whiting
�O Epites
t Commission GG 339912
P 05f2972023
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