HomeMy WebLinkAboutMalanczyn Building Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZI !o /',a13 Permit Number:
giro WCGE
' Building pp Permit Application
Planning and Development Services
Building 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:
r�
I PROPOSED IMPROVEMENT LOCATION: I
Address:
PropertyTaxlD#:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
>: ruin t M pce l 4 be"k
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
_ Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1 -'7/ odo
_ Generator
Sq. Ft. of First Floor:
Lot No. ,
Block No. ° :1
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer Septic Building Height:
0 W N ER/LESSEE:
CONTRACTOR:
Name 177' lar, r
Name: Ka dL 64i76c tL
Address: �-7.55 S roc '5'n;W ,i•
_
Company: f/l�, Cu-(o� S.W 015
City: ft. Pierce -State: /_1
Zip Code: 3 y f4 y Fax:
Phone No. 7 % 2 4 ? y'1,12 4 E-
Address: �626-)q 1'LC_nD )&,
City: Ae State:
Zip Code: ,:?Li f $O Fax:
Phone No 77-- ;-F6- 7e)33
Mail: J rA o,LA . j LZvtl e Avl. GUM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail s4Cc pools & $4indc.1. COm
State or County License
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:
Name: A'ee.,a
Not Applicable
MORTGAGE COMPANY:
Name:
2L Not Applicable
Address: Y3 S, Sw P n6ar AV&.
Address:
City: 54-uW.51
Zip: 14"Iffl Phone I
State: T, I
- 4a— 1363-3343
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
k� Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 lenricr nr nn nttnrnov hpfnro rnmmpnrinp work nr recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF F% (An
Sworn to (or affirme ) and subscribed before me of
Physical Presence or _ Online Notarization
this day ofe n.. ti 20Ra- by
Skr, M06fan61'yn
Name of person making statement.
Personally Known V-11" OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
_ale h
G [ 4F
Commission No. 1 wJ (Seal)
Notary Public State d Fbiids
Ryan F. Siack
,s
My cammisaion GG 95o9o5
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Ezpna 01128t2o24
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21