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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date: 5/2, /2021 Permit Number: Q'-Nc '-'G
Planning and Development Services
91r.
° Building Permit Applicat`
Building and Code Regulation Division Commercial XX
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED 4MPRO,,VEMENT LOCATION: „
Address: 5055 N Highway AlA Unit 706
REcFNBp
Ion SUN 2021
Permitting Depa
Residential St. Lucie CoUntent
Property Tax ID #: 1414-601-0144-000-0 Lot No.
Site Plan Name:
Project Name: Seidenberg Residence
Block No.
DETAILED DESCRIPTION:OF"1NORK:
Remove all existing flooring & replace with tile; Remove and replace kitchen cabinets, fixtures, appliances, & replace; Remove
wood trim & replace; Remove bathroom fixtures, vanities, shower curbs, & replace; Update electrical systems, gfci's,outlets,
Iswitches & replace; Remove old copper piping & replace with Pex and CPCC; replace all bathroom fixtures and trim;
New Electrical Meter Second Electrical Meter
['CO'N'STRU'CTIQ'U INFORMATION. p4 �j
Additional work to be performed under this permit — check all that apply:
Mechanical
X Electric
Gas Tank
X Plumbing
Total Sq. Ft of Construction: 1,300
Cost of Construction: $75,000
Gas Piping
_ Sprinklers
Shutters _ Windows/Doors _ Pond
Generator
Sq. Ft. of First Floor:
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE: n .
CO-NTRACT.OR::
Name Brenda Wiencko Donovan and Paul Jay Seidenberg
Trustees of the Revocable Living Trust
Name:
Company:
C3Z-CR-t`�O
Address: 5059 N Highway A1A 701 B
City: Fort Pierce State: FL_
Zip Code: 34949 Fax:
Phone No. 774-487-8541
Address:
5D i
[( ore,
City:
Zip Code: Fax:
Phone No - Lto
State —L,, I�
(� `C
Cl
E-Mail: pjseidenberg@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail E�t'y_ • Ina)
�V 15
State or County License(
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.
ORMATIO SUPPLEM ENTAL"CONSTRUCTION INN N:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: �D Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: __loot 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 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')CQmmen oement.
Signature of Cw—nerwl Lessee/Cofff-ractor as Agent for Owner
Sign-aTure of ContractoyLicense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF —=I , /-) : A � fL
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
K Physical Presence or Online Notarization
VPhysical Preseppe or Online Notarization
this JO day of M Ay 2020 by
this 2&�hclay of ()ap4j—� 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of identification
Produced P1c>v,0P L.;C-:"J.s=
Produce t-\ olo".,
JESSICAWHELCHEL
A� -.'I my CQMMISSION # GG 036646
(Signature of Notary Public -State of Florida
f Florida0'
C SNJ7
(Si nat tary Pu 'Aft Fl orWl�ES: February 5,2D21
�DW UndarAters
�jN
stateot�lo
Commission No. G Cm 1 '23
4 Bonded Thru Notary Public
fission No.
320
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