HomeMy WebLinkAboutKelly ApplicationAll 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 Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 1328 Lancewood Terrace
Address: 1328 Lancewood Terrace
Property Tax ID #: 4426-804-0018-000-7 Lot No.
Site Plan Name: Kelly Residence Block No.
Project Name: David & Jill Marie Kelly
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Installation of a Pool Screen Enclosure
New Electrical Meter Second Electrical Meter
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Additional 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: Sq. Ft. of First Floor:
Cost of Construction: $ 13670.00 Utilities: —Sewer _ Septic Building Height:
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Name David or Jill Marie Kelly
Name: Craig Rice
Company: Pioneer Screen LLC
Address: 1328 Lancewood Terrace
City: Palm City State: _
Address: 3290 SE Slater Street
City: Stuart State: FL
Zip Code: 34990 Fax:
Phone No.443-995-3127
Zip Code: 34990 Fax: 772-283-3028
E -Mail:
Phone N0772-2839197
Fill in fee simple Title Holder on next page ( if different
E-Mailgev@pioneerscreen.com
State or County License SCC046064
from the Owner listed above)
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.
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Signature 4 O ner/ Lessee/Con cto s Agent for Owner
Signature of Contr ct r/License Holde
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Swor to (or affirmed) and subscribed before me of
esen a or On
Physical Prline Notarization
Name:
Address:
t i ay of Qt` _ r 2020 by
Address:
City:
State:
City: State:
Zip: Phone
Name of peUn making statement.
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Type of Identification
Name:
Address:
Address:
City:
(Si nature of Notary Publi Stat
City:
Zip: Phone:
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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
/ lencle-Lor an attorney before commencine work or recordine vour Notice of Commencenaent.
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Signature 4 O ner/ Lessee/Con cto s Agent for Owner
Signature of Contr ct r/License Holde
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Swor to (or affirmed) and subscribed before me of
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Physical Prline Notarization
Sworn t (or affirmed) and subscribed before me of
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th• day of _,2020 by
t i ay of Qt` _ r 2020 by
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Name of peUn making statement.
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Personally Known �' OR Produced Identification
Type of Identification
Type of Identification
Produced
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