HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 2 �+
Date: 6-4-2021 Permit Number: / " U _33 /
RECEIVED
° JUN 1 JL' JfD
p ° Building Permit Application St. Ludtd
Planning and Development Services Permitting���201'
Building and Code Regulation Division Commercial x Residential Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 SL.Woe County
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Bath Room Remodel 4up �Jc�tj
PROPOSED IMPROVEMENT LOCATION:
Address: 9550 S_ Ocean dr Unit 1902 Jensen Beach FL 34957
Property Tax ID #: 4502-601-0176-000-2
Site Plan Name: Islandia I Condominium Unit 1902
Project Name: Mandel
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.
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: 1200 Sq. Ft. of First Floor:
Cost of Construction: $ 32'000.00 Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR: '�
NameBrian & Marcy
Name: Robert Helmsorig
Address:9550 S. Ocean Dr Unit 1902
Company: Renovation Technologies
City: Jensen Beach State: _
Address:21569 Battery Park Terrce
Zip Code: 34957 Fax:
City: Boca Raton State: FL
Phone No.215-810-1826
Zip Code: 33428 Fax:
E-Mail:bemandel7@gmail.com
Phone No954-632-0698
Fill in fee simple Title Holder on next page (if different
E-Mail renovationtechinc@yahoo.com
from the Owner listed above)
State or County License CGC1 522634
IT value or Construction is zbuu or more, a RecuRUEU 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:
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 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
v1th lender or arLattornev before commencing work or"cording your Notice of Commencement.
Ak_�__e "/W,
r
Signature of Owne / Lessee/Con tr or as Agent for Owner
Signature of Contractor/License Wder
STATE OF FLORIDA -
Lao C>
STATE OF FLORIDA /
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COUNTY OF .
COUNTY OC
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
vC Physical Presence or Online Notarization
Physical Presence or Online Notarization
this 16' day of Swni✓ 2024 by
this —/-p day of -)one. , 202t by
Kc9W4�oi /l%IgllatS
/<ov114 �� �F'
Name of person making statement.
Name of person making statement.
Personally Known *6 OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ignature of Nota -
:'1� ' RONALD JAMS NARBUTAS
�.1
(Si ature of Nota
'ir�r po"'• RONALD DAMES NARBUTAS
NotaryPublifFC StAtSe� of Florida
Commission No. V CommissiDrl, W 028442
`?° •`: Notary Public f Florida
Commission No. `
My Comm. Expires Aug 5, 2024
Commissioi 8442
°�
of rti,. ` My Comm. Expires Aug 5, 2024
Bonded through National
8
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