HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /J [�1/
Date: Permit Number: _C Q 60 —G / / 7
RECEIVED
44o bL1000� -
o .
Q , - ° B. Building Permit ApplicationFsr.
JUN 17 2020
ucie County, Permitting
Planning and Development Services
Building and Code Regulation Division Commercial DL Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1S53 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 808 Shorewinds Drive, Ft. Pierce, FL 34949
Property Tax ID #: 1425-701-0017-000-2
Site Plan Name:
Project Name:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
General
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction: Cost of Construction: $ ' -7e 36 f
_ Gas Piping
_ Sprinklers
_Shutters _Windows/Doors _Pond
_ Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameThomas Kolano
Name: a�
Address:17 Ringler Drive
Company: d
City: East Northport State: _
Zip Code:11731 Fax:
Phone N0.631-455-7211
Address: /j/;.2 5-
City: t�lCrx.r�
Zip Code: :zz�yr✓ Fax:
Phone No 7 7Y - d l'f ciP1�70
State:FG
E-Mail:twkolano@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail</L,AS �v
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State or County License S' GQG
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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/ENGINEEIj� _
Name: fegrT CAL e��r
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: d
Address:
City: r n
Zip: 123E7 Phone-2u-.202-4WVr
State: %4
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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.
no
re the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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.
J�
Signature cl(tner Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF
COUNTYOF
Swo to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this')1 day of J0VVR 2020 by
this _ day of 2020 by.
1
1 ^lo�UV S Y—olan 7
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification V/
Personally Known OR Produced Identification
Type Iden ificy�t(on
Type of Identification
_ 21nu' �: G 4
Produced ii ��JJ �p
c
Produced
(Signature of Notary Public- a @ • , on a SSANDRAM VOLAGE
(Signature of Notary Public- State of Florida )
z;P • •`: Notary Public -State, f Florida
2J GG 9232t0
Commission No. y? (SgWlssion r
'•`�•,pr11;v fay Comm, Expires Oct 16, 202
ommission No. (Seal)
"••Bonded through National Notary Assn
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Rev.S/6/20