HomeMy WebLinkAboutKukla Permit APP ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Residential X
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1107 KINGSWOOD LN
Legal Description: DRIFTWOOD MANOR-SECTION TWO-LOT12(0.49 AC) (OR 3766-476)
Property Tax ID#: 3404-807-0012-000-3 Lot No.12
Site Plan Name: Kukla Block No.
Project Name: Kukla
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove existing 200 AMP panel and sub panel and replace like for like
Upgrade grounding
CONSTRUCTION INFORMATION:
Additional worK to De Fie orme un er tIiis permit—c ec a Bat app y
13HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
zElectric Plumbing O Sprinklers E Generator 0 Roof Roof pitch
Total Sq.Ft of Construction: 2786 S .Ft.of First Floor:
Co
st of Construction:$ 2460 Utilities Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Paul G Kukla Jr Name: Donald B Green
g
Address:
1107 Kin swood Lane Company: Don Green Electric LLC
City: Fort Pierce State:FIL Address: 1305 W 1st Street
Zip Code:
34982 Fax: City: Fort Pierce State:FL
34982
Phone No. Zip Code: Fax:
E-Mail:
Phone No. 772-418-5739
Fill in fee simple Title Holder on next page(if different E-Mail: dongreenelectric@gmail.com
from the Owner fisted above)
State or County License: EC13007447
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: Not Applicable
Name:" Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: i 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 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
conrviricing work or recording our Notice of Comme cemerA.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MARTIN COUNTY OF MARTIN
The ijbrgod g instr ent as acknowledged fore me The forgoing instrument was acknowledged before me
this t day of 20 y this 18th day of October 20� by
DONALD B GREEN DONALD B GREEN
Name of person making statement Name of person making statement
Personally Known X OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Procwced Produce
I MA A
(Signs re If
Nota Public-State of FI rida) (Signature f Notal Public-State of Florida)
r" JOY C I N COPELA 0 aY p� JOY CHRISTIIIE C,�PELAND
Commission No. Commission(!I~ 9118042 Commission No. o`r - Commissi 0 48042
IseCommission Expires My Commission Expires
Januar 5,2020 January 5,2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17