HomeMy WebLinkAboutklansky permit appAll 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 I�
2300 Virginia Avenue, Fort Pierce FL 34332
Phone: (772) 462-1553 Fax: (772) 4E 2-1578
PERMIT APPLICATION FOR:�kr,
PROPOSED IMPROVEMENT LOCATION:
Address: [ s1Ir- `�I?a ti1.rrX FL_ 3y�j
Luce C'l7� �11
Property Tax ID #: 4 5 C5';� - cL, t� 1 _ C) 13 0 l Lot No.
Site Plan Name:
Project Name:
I DETAILED DESCRIPTION OF WORK:
�.. c' 4'w r1 1 � }tia- � � � � t- r�. r�� o � �'� L-- L� � °�. 4 � c s Sl �.� � -`r (.._1f�_i{� U �] ra+ea � c , ,. i •�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
✓Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1 S Do. 00
OWNER/LESSEE:
Block No.
_ Shutters _ Windows/Doors _ Pond
Generator Root Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Bu Iding Height:
CONTRACTOR:
Name 1 Y I. ,r< ci C..
Address: LI21 0
City: i 6L State: y�
Zip Code: 1 1 Fax:
Phone No. 3`l - 3 'Slo- S`fo`i
E-Mail:cLr`Y--% l rn`i e^
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Add ress: '335 o C- S i-' - 1, rn D,-,
City: i�',-c, State: FL
Zip Code: 34 c[ S -7 _ -ax:
Phone No 'GO - 8.0 S �
E -Mail b 33 c -D 5 V 11 CA , <u
=r
State or County License LvL,;-, j- L4 -2,p �S1
tf2 1_3.'I 51jS70
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/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
l
FEE SIMPLE TITLE HOLDER: _ 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 wo-k and installation as indicated.
I certify that no work or installation has ccmmenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit hclder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and co,renarts that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for Eny restrictions whit-) may apply.
In consideration of the granting of this recuested permit, I do hereby agree that I will, in 311 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: roam additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses tc 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 reccrded 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 our Notice of Commencement.
gnature of Owner/ Lessee/ n ctora`s g_enifor-ON!T_re
of Contractor/License H--)Ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF t ,,- -V-, y-1
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmec) and subscribed be=ore me of
_4,,L—iysical Presence or Online Notarization
iPhysical Presence or Online Notarization
this _"ay of 2020 by
this.2&r`rffay of L c- -& mac 2020 by
7i C' 1CY-� S 0 . _t-:� YzJ (-, y a
c_ yY-'e- � -D --.C) �✓v
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Name of person making statement.
Name of person making stEtemen-.
Personally Known l. --OR Produced Identification `'
Personally Known C_49_� Produced dentification
Type of Identification
Type of Identification
Produced k- t,
Producedl—tVv kat¢ _Dv + 0'7s
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission NoG `I Y
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DATE
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DATE
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