HomeMy WebLinkAboutEC Permit App 5602 Killarney AveAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q ' 3D ' ZI Permit Number:
Lrl CME,,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential v/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 'Jla02 V-I IIL4-n-itii A^Ye-
PropertyTax ID #: 13o 1 - (o I g - O 389 - UW Lot No.
Site Plan Name:
Project Name: IGc 54cA l2 es
DETAILED DESCRIPTION OF WORK:
079 k.
exfe. dyort +c, new loco—H sy-i -fay Attu
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical
✓Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
_ Sprinklers
(Affidavit required)
_ Shutters -Windows/Doors _ Pond
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OW N ERAESSE E:
CONTRACTOR:
Name f-k._rel d 14dc (
Name: Mfc-I,,IA[-1 Pn'dc
Address: SfaD 2 Y-t I V�' " _, by C-
Company: Pr ide Ft cc--M rai S ,,,Ar s of FL
City: Far+ ?c � e State: F _
Zip Code: 3441 S I Fax:
Phone No. E-
Address: 84 3 S. IL-; a S HKI 4
City: e4.?I6rcc State: Fv-
Zip Code: 3q IC I Fax:
Phone No -t 12 - 3`1 a (o BA9
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail rr i ci - Icc'cn l . c
State or County License lL 13on s B Sl
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: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _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 conflicts with any, applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 po the jobsite before the first inspection. If you intend to obtain financing, consult
with lendff-oLen attorney Uefore commencing work or recording your Notice of Commencement.
44 � I
SIghSt6re of Owner/ Le Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S+. Lucia
Sworn to (or affirmed) and subscribed before me of ✓
Physical Presence or _ Online Notarization
this 30 day of 6" ir_m bey . 207-L by
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification Produced
(Signature of Lary Pu lic- State of Florida)
CHRISTINA SAVAGE
,=
Commission No. (Seal)
_ Notary Public -State of Florida
Commission N GG 910736
My Commission Expires
September 05, 2023
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21