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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ' `�(
Date: Permit Number: [ 91 V(, — L V b t/
9 LTo WC ULE RECEIVED
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Building Permit Application JUPi ® 2021
Planning and Development Services permitting Department
Building and Code Regulation Division Commercial Residential 5t, Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Randy & Dorothy Burton
PROPOSED IMPROVEMENT LOCATION:
Address: 5313 Sunset Blvd
Property Tax ID #: 3402-608-0485-000/2
Site Plan Name: Indian River Estates Unit 7
Project Name: Burton Generator
DETAILED DESCRIPTION OF WORK:
Install conduit and wire for owner supplied generator e, A r
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.45
Block No. 52
.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: Sq. Ft. of First Floor:
Cost of Construction: $ 2,400.00 Utilities: —Sewer _Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name Randy Burton
Name:John Malanczyn
Address:5313 Sunset BV
Company: Malanczyn Electric, Imc
City: Ft Pierce State: _
Zip Code: 34982 Fax:
Phone No. 772-519-0336
Address:1535 S Niemeyer Circle
City: PSL, State: FL
Zip Code:34952 Fax:
Phone N0772-263.9129
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailjmalanczyn@aol.com
State or County License EC-0001492
it value of construction is 25UU 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 TITLEHOLDER: _ 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
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sw rr erfsi affirmed) and subscribed before me of
Physical Presence or Online Notarization
Ph sical Presence or Online Notarization
this day of 2020 by
this day of Mrad _ 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced IdentificationL,--
Type of Identification
Type of Identificattfl
Produced
Produced
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(Signature of Notary Public- State of Florida)
(Signature of Notary Public- too Florida) -
Commission No. Seal
(Seal)
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