HomeMy WebLinkAboutSigned and Noterized PermitBuilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462--1578
Commercial Residential X
PERMIT APPLICATION FOR: KlrSten A BeSankO
PROPOSED IMPROVEMENT LOCATION:
Address: 21210 glades cutoff rd
Property Tax I D #: 4221-232-0039-000-6
Site Plan Name: Glades Cutoff Rd
Project Name: Impact windows
DETAILED DESCRIPTION OF WORK:
To Install 9 impact windows and 4 mull bars
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 Shutters
— Electric _ Plumbing —Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 8,625.00
Generator
Y—Windows/Doors
Sq. Ft. of First Floor:
Roof
Lot No,
Block No.
utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CON
Name Kirsten A Besanka
Namc
Address: 21210 Glades Cutoff Rd
Comp
City: fort St Lucie
State: �-L
AddrE
Zip Code. 34987 Fax:
1
City: .
:
Phone No. 772-464-7457
Zip c
F-Mail:
PhonE
Fill in fee simple Title Holder on next page { if different
£-Mai
from the Owner listed above)
State i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� 22�2.ca Permit Number:
LU!L
LC C C 1•„ F 1,T
Pond
Pitch
TRACTOR.
: Ryan Mills
any: Trenton King Inc
ss: 2332 SE Jackson St
'tuart State: FL
de: 34997 Fax:
No 561-307-8493
Trentonkinginc@aol.com
)r County License CGC1528078
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
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 our Notice of Commencement.
Sig ature of Owner/ Lessee/Contractor as Agent for Owner Signature of C ntra r/License Holder
STATE OF FLO)31 A STATE OF FLORIDA
COUNTY OF [ COUNTY OF F%,c.w,
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
'0-Physical Presence or r Online Notarization IrPhysical Presence or Online Notarization
this day of AIAA 1. i� , 2020 by day of PVJtNn� 2020 by
NA s
Name of person making statement. Name Vf person making statement.
Personally Known G OR Produced Identification
Type of Identification
ProducedL-
"40-
{Sign ure of N ar #AFWda
ichaei James Mills
Commission No. (r Mr a°.r+msG 97g824
:w j11YES d1"'.,E 4
Personally Known OR Produced Identification
Type of Identification
Produced 11--L-OL
(Sig6atCPF9-bf No � Public- t l loi jW�aj� public State of Fk ida
Michael James MiHs
Commission No. �s" 14�1(%9M"On GG 970824
p� yid' ExAireg 18M24
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rev. DI o/ cU