HomeMy WebLinkAboutAppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit NGmber:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential t/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 2319 Dyer Rd, Port Saint Lucie, FL 34952
Property Tax I D #: 3414-501-1408-250-2 Lot No.
Site Plan Name: Block No.
Project Name: E!:j Karol Mieczyslawa Karolewski
DETAILED DESCRIPTION OF WORK:
Replacement 6 Niindoivs 9-e-
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _zwiraows/Doors _Pond
Electric _ Plumbing _ Sprinklers Generator _ _ Roof Pitch
Total 5q. Ft of Construction: _
Cost of Construction: $ 11,000
Sc. Ft. of First Floor:
Utilities: 5ew!er Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameE!t Karol Mieczyslawa Karole..sici
Address: 2319 Dyer Rd
Name: rt e
Company: Newsouth Window Solutions
City: Port Saint Lucie State: FL
zip Code: 34952 Fax:
Phone No.(772)607-0264
E-Mail:
Address:2526 Okeechobee Blvd.
City: West Palm Beach State FL
Zip Code.33409 Fax:561-478-4100
Phone No 561-712-9000
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail permits-wbp@newsouthwindow.com
State or County License- - - SCC .5
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is 57,500 or more, a RECORDED Notice of Commencement is required.
)I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ,Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Add ress:
Ad d ress:
City: State:
Zip: _ Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Add ress:
City:
City -
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to dome 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 Horne Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, 1 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 corcurrency review: room additions,
accessory structures, swi-nming 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 o Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIRA` �
COUNTY OF tilCc Vn
Sworn to (or aff rmed) and subscribed before me of _ZPhysical Presence or Online Notarization
of p �`{�1r�Q��, _`,,26a by
this day r`
�1'�!� Yy a ; Y� Ii s
Name of per on making statement.
Personally Known OR Produced nt}}'fication 4—
Type of Identification Produced L---
(Signature of Notary Public- State of Florida }
�� KARL GORKA JR
Commission No. r��� (seal) zo"�"YP °fc $taro of Florida -Notary Public
CPmmis_ n A GG 176622
My Corn miss Expires
J;+ ivary 17. 2022
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