HomeMy WebLinkAboutKORNILOFF APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential
Address: �l �fi�(C� `� CC f'_n o br, 4 -I-I Ll 3z1qS-7
Property Tax ID #: u` 0 ' �G , rJo-y - oco Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
G
CONSTRUCTION INFORMATION:
4
Additional work to be performed under this permit- check all that apply:
Block No.
_Mechanical
_ Gas Tank
_ Gas Piping
_ Shutters
V Windows/Doors
_ Electric
_ Plumbing
_ Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ I"7 , z1,e-q
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
OWNER/LESSEE: I CONTRACTOR:
Name � (F A Kotn, I ��
Address: 9 CA L16 -�g
.�
City: uE�-i'7`SE'_o TJe('zm State: 11
Zip Code: Wcl'T Fax:
Phone No. 7-U-.2 l y --05M
E-Mail: „1zA1_'rl �GZG(`( t'��lYlr'�1.5f• 11�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height: 1190
Name:... A13re_ll Le-hma rr)
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Company•,,"�A-cz 1Qukic(
I )C i S
Address: 312,5- _L N L'i� �� �� L
xl .
City: W-e-S-1 P0,,1 Pj,e"
Stater
Zip Code: 3�3740zj Fax:
02- ILI /41
Phone No 174I -d42- ILll,�
E-Mail KKf�- � 6o, 1pyit;�c' j✓Y]/?Ct['`
ttjr/1�� 1IL-1C
State or County w
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC 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 Ap 'cable
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TIT L LDER: — Not Applicable
BONDING C/r�amY: Not Applicable
Name:
Name:
Address:
Addre
City:
Ci
Z Phone:
ip: 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Le e/Contra t r as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLO DA
COUNTY OF n,I al
The forgoing instrument was acknowledged before me
this (L day of > 20-� I by
The forgoing instrum Cnt was acknowledged befornie ,r
this � day of [C/ 0 20_� ! by s NO
1�
9
Name of person making statement.
Name of person making statement. ' 'Qa o
Personally Known _— OR Produced Identification
Type of Identification
Produced
P� KIMBERLYAKE6.%Y
Commission # GG 208493
l `4 Commission Expires 04 9 8-2022
AnAdAd 1t
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Personally Known OR Produced Identifica oy= � -
Type of Identification o a t a es
es
Produced C s y.m
' ' _ ''
aS
j a c)
c= g N
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(Sj natureNot ry P e of F )ilotary Public
Commission No. (Seal)
(Si ature of otary Public- Sta f Florida)
Commission No. ��`�j /ice (Seal) ,
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FRONT
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COMPLETED
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