HomeMy WebLinkAboutGruszka application correctedALL 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 34952
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
0
PROPOSED IMPROVEMENT LOCATION: �ij
Address: 138 SE LUCERO DRIVE
Legal Description: RIVER PARK - UNIT7 - BLK 71 - LOT 5 (MAP 34128S) (OR 214-1540: 706-813 THRU 871)
Property Tax ID #: 3419-550-0128-000-8
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
NEW SHOWER VALVE AND VINYL PAN IN GUEST BATH
CONSTRUCTION INFORMATION:
A itiona wor to e er orme un er t is perrn�t — c ec a app y:
HVAC M Cas Tank ❑Gas Piping rnShutters
Electric 21 Plumbing Sprinklers M Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 500.00
OWNER/LESSEE:
NameJOHt* P GRUSZKA
SFt, of First Floor: _
Utilities:]Sewer Septic
Address:138 SE WCERO DR
City: PORT ST LUCIE State:FL
Zip Code: 34983 Fax:
Phone No. (772) 879-6037
E -Mail -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No. 5
Block No. 71
Windows/Doors
Roof Roof pitch
Building Height:
CONTRACTOR:
CIO
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
0
PROPOSED IMPROVEMENT LOCATION: �ij
Address: 138 SE LUCERO DRIVE
Legal Description: RIVER PARK - UNIT7 - BLK 71 - LOT 5 (MAP 34128S) (OR 214-1540: 706-813 THRU 871)
Property Tax ID #: 3419-550-0128-000-8
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
NEW SHOWER VALVE AND VINYL PAN IN GUEST BATH
CONSTRUCTION INFORMATION:
A itiona wor to e er orme un er t is perrn�t — c ec a app y:
HVAC M Cas Tank ❑Gas Piping rnShutters
Electric 21 Plumbing Sprinklers M Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 500.00
OWNER/LESSEE:
NameJOHt* P GRUSZKA
SFt, of First Floor: _
Utilities:]Sewer Septic
Address:138 SE WCERO DR
City: PORT ST LUCIE State:FL
Zip Code: 34983 Fax:
Phone No. (772) 879-6037
E -Mail -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No. 5
Block No. 71
Windows/Doors
Roof Roof pitch
Building Height:
CONTRACTOR:
Name:
Company:
I
Address:`
City:}-
Zip Code:
Phone No.'r'�
Fax:
Stater
E -Mail:
£� f
State or County License:
If value of construction is $2500 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: Applicable
_Not
Name: Name:
Address: Address:
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 hofder to build the subject structure
which is in conflict with any applicable Home Owners Association bylaws
rules, 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. j
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 our Notice of Commencement.
SPgnature of Owner/ see%Contractor as Agent for Owner _ gnature of Contract r/Licenses FF6 lder
STATE OF FLORIDA STATE OF FLORIDA,— ,
COUNTY OF
COUNTY OF ;