HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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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
PERMIT APPLICATION FOR: John Malanczyn
PROPOSED IMPROVEMENT LOCATION:
Address: 12063 S Indian River Dr
Property Tax ID #: 4504-602-0006-000-9
Lot No. 6
Site Plan Name: Block No.
Project Name: Malanczyn Residence
DETAILED DESCRIPTION OF WORK:
tear off existing shingle roof down to plywood and replace with new.
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
AT
Total Sq. Ft of Construction:
Cost of Construction: $ -2_ q, 5 V0 -
_ Gas Piping _ Shutters _ Windows/Doors — Pond
_ Sprinklers v Generator _t Roof q / Z Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name John Malanczyn
Name: CoUf%I{:RMO 5"AU14
Address: 12063 S Indian River Dr
Company: LH k0Cr-1/UC- INC
City: Jensen Beach Stater
Zip Code: 34957 Fax:
Phone No. 772-263.912+9
Address: 2i%q 5c 66t4k/PA tC ;r
City: ;—r"IAILt State: �L
Zip Code: ml v Fax:
Phone No YV%2_"' 95- M3
E-Mail: jmalanczyn@aol.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 4l% � �i/�FI t� e/lr� • 40/"/
State or County License F101- )AI
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: , Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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.
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 attorney before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature o ontractor l ense Holder
STATE OF FLORIDA
L4A=cv?_,
STATE OF FLORIDA
COUNTY OF H4ayi41
COUNTY OF \r`+
Svio96 to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Prese,pcor Online Notarization
_�? Physical Presence or Online Notarization
this ,?W day of e-1 r� 2020 by
this 27Z day of J UL�l 2020 by
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Name of person making statement.
Name of person making statement.
Personally Known O !1�6A�'
Personally Known OR Produced Identification
Type of Identification �V DIANEC LE
': Nctary Public -State of Florida
Type of Identification
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Commission No. & G `� (4' 1 I'�o/ (Seal)
Commission No. 61 G? �3,5 69 (Seal)
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Rev. 5