HomeMy WebLinkAboutKellett slab permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01/13/2021 Permit Number:
LLLEC
N.
L U
L 01 I� I: L tz _= Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
PERMIT APPLICATION FOR:New 40" X 80" X 6" THICK Concrete Pad For Generator
PROPOSED IMPROVEMENT LOCATION:
Address: 2014 NW Royal Fern Court
Property Tax ID #: 442 5-605-0021 -000-7
Site Plan Name: Kellett Residence
Project Name: KELLETT GENERATOR SYSTEM
DETAILED DESCRIPTION OF WORK:
SUPPLY & INSTALL A NEW 40" X 80" X 6" THICK CONCRETE PAD FOR 22 KW GENERATOR
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot N o._
Block No.
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: _
Cost of Construction: $ 600.00
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
NameLAEL KELLETT
Name:JEFFERY J PAULY
Address:2014 NW ROYAL FERN COURT
Company: Jeffery J Pauly Construction Inc.
City: PALM CITY State: _
Zip Code: 34990 Fax:
Phone No.772-807-7488
Address:2420 SW Maplewood Dr_
City: PALM CITY State: FL
Zip Code: 34990 Fax:
Phone N0772-263-8268
E-Mail:lkellett@aol.com
Fill in fee simple Title Bolder on next page ( if different
from the Owner listed above]
E-Mail ltpcbclp@gmail.com
State or County LicenseCBC047770
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: T 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 Nome 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 attorne"efore commencing work or recording your Notice of Commtnrr)ment.A__
for Owner
STATE OF FLORIDA STATE OF FLORIDA U
COUNTY OFQ: -�� COUNTY OF
Sworn (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 14 day of 2021 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this itl day of ,1q�.,.< ry 204 by
Name of person making statement -
Personally Known Y OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- Sta., f
gnature of Notary Public- Sta
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Pro
otary Public State of Flora
err Yy Notary Public State of Florid
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