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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: IO'dd C2 Permit Number: aM
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Building Permit Applicatio OCT 2 1 2019-1
Planning and Development Services
/ ST. _ e County, Permitting .
Building and Code Regulation Division Commercial V Resl
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 29 LAKE VISTA TRL 103
Property Tax ID#: 3422-500-0395-000-5 Lot No.
Site Plan Name: Block No.
Project Name: GOLINSKY
[DETAILED DESCRIPTION OF WORK
REPLACE 2 WINDOWS WITH IMPACT.
USING LIKE SIZES, NO STRUCTURAL CHANGES BEING MADE
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 Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 3200 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name James Golinsky M1 Name: "BRUCE M. TYRRELL JR.
Address: 29 Lake Vista Tr#103 Company: Kamrell Windows & Doors
City: Port St Lucie 5tate :FL.Y,, 'Address- 8200 SW LOST RIVER ROAD
Zip Code: 34984 Fax: city: Stuart State: FL
Phone No. 772-359-0912 • Zip Code: 34997 Fax:772-288-6208
E-Mail: JAMESGOLINSKY@YAHOO.COM Phone No 772-288=6205
Fill in fee simple Title Holder on next page(if different E-Mail Sue Kamrell.com
from the Owner listed above) State or County License CGC061180
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 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
with lender or an attorney before commencing work or recording our Notice of Commencement.
UGl f'7-�
Signature of Owner/Lessee/ ntractor Agent for Owner
STATE OF FLORIDA
COUNTY OF-
Sworn to(or affirmed)and subscribed before me of V Physical Presence or Online Notarization
this day ol 20J by
&ate J-rt
Name of person making statement.
Personally Known V OR Produced Identification
T pe of
Identification Produced
(Signature of Notary Public-State of Florida)
� All•., SUSAN MARIE G06DARD
Commission No. (Seal) ?°• ^` Notary Public-State of Florida
Commission#HH 033062
'''FoF ryo My Comm.Expires Sep 25,2024
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21