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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9 �;z' ;� Permit Number:
a�oa• C70�
12To ("I UCE RECEIVED
Building Permit Application
FEB 0 2 2022
St.Lucie VounPlanning and DevelopmentServices PermiBuilding and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR: WINDOWS/DOORS
P.ROPOSD,INIPRO�IEMENT LQCATIQN:
Address: 4380 Indrio Rd Fort Pierce, FL 34951
Property Tax ID#:1418-143-0035-000-0 Lot No.
Site Plan Name: - .J t& oC ' Block No.
Project Name: Krulisky#11728
DETAILEDDESCRiPTIQN QF WOR[C•
n=
REPLACE EXISTING WINDOWS W/ IMPACT f 0wi
New Electrical Meter Second Electrical Meter (Affidavit required)
�CONSTRUCTIQN INFORMATiQN. ;
8 Y�
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:$ 17100.00 Utilities: —Sewer —Septic Building Height:
-
QWNER/LES$EE:' CONTRACTOR
Name John & Gwynette Krulisky Name: ALPHONSE CAMPANELLI
Address:4380 Indrio Rd Company: STORM TIGHT WINDOWS
City: Fort Pierce State: FL Address:500 SW 12TH Ave
Zip Code: 34951 Fax: City: DEERFIELD BEACH State: FL
Phone No.(772)332-1976 E- Zip Code: 33442 Fax:
Mail: JD.KRULISKY@HOTMAIL.COM Phone No 561-420-0271
Fill in fee simple Title Holder on next page(if different E-Mail stormtightpermits@outlook.com
from the Owner listed above) State or County License CRC 046091
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.
SUPPLEMENTALCONSTRUCTt t N 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 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 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.
i
Signature of Owner/Lessee/Contract nt for Owner
r
STATE OF FLORIDA
COUNTY OF_ U,LG_t_ —
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this day of'SCllnc,��Ll 20��by 9
v('u I ski
Name of person making statement.
Personally Known OR Produced I ent'fication
Type of Identification Produced
G'i2r.-k
(Signature Notary Public-State of Florida)
Commission No. /7 /002AV(Seal) E
'tip;: MARGARITAS.PETERS
MY COMMISSION#HH 100248EXPIRES:April 19,2025.di�?Qr Bonded ThN Notary Public Undervrtit's
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21