HomeMy WebLinkAboutLytwniuk Permit Application _20211004_162853All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10.4 Permit Number:
1_- c 0 ..Q c c t Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: LytWyniuk-10102
PROPOSED IMPROVEMENT LOCATION:
Address: 10102 S Ocean Drive #708A Jensen Beach FI 34957
Property Tax ID #: 4502.802.0065.000.8 Lot No.
Site Plan Name: Block No.
Project Name: Lytwyniuk-10102
DETAILED DESCRIPTION OF WORK:
Install new 2-ton 15 seer 5kw Rheem complete system
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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: $ 4400.00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Mary Ann Lytwyniuk
Name: LUKE WALKER
Address: 10102 S Ocean Drive Dr #708A
Company: TREASURE COAST AIR
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No. 772-999-4944
Address: 1055 S.W. MARTIN DOWNS BLVD
City: STUART State: FL
Zip Code: 34990 Fax: 772-288-7046
Phone No 772-692-1701
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail TCAC1990@ATT.NET/TCACSVC@ATT.NET
State or County License CAC058476
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: x Not Applicable
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x 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 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 attornev before commencing work or recording vour Notice of Commencement.
Signaf re of Ow L see/Contractor as Agent for Owner
Sign atu a of Con ct License Holder
STATE OF FLORIDA
STATE OF FLORIDA
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COUNTY OF � 14AI-2 /•�
COUNTY OF /E'1n2% /
Swo to (or affirmed) and subscribed before me of
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Ph sical Presence or Online Notarization
this � day of �G% 200by
this -7 day of 4G% 20* by
Name of person making statpme—nt.
Name of person making s!9�ement.
Personally Known V /OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
vAP—*
Produced
(Signatur of Notary Pu ic- State of Florida
(Signa of Notar Public- State of Florida )
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