HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI' A,
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ll
Date: �;� SCANNED Permit Number: .I' _(2 Cp
BY
St. Lucie County FRECEIVE
_..__2__ Z .6___ __ __ Building Permit Application Nov -5 2919
Planning and Development Services
Building and Code Regulation Division Permitting Departme
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FI
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resi
PERMIT TYPE:
p��Ca�)r.a,, Crwcaa2
PROPOSED,IMPROVEMENT LOCATION:
Address: 6009 Paleo Pines Circle, Fort Pierce, Florida 34951
Property Tax ID #: 1312-801-0141-000-0 Lot No.338
Site Plan Name: Block No.
Project Name:
[DETAILED DESCRIPTION OF WORK: <
Construction of new garage. '21 , X ;z /9 i 0 R - Q r 8 u J T i�,= 1A _ CT) v O AJ -
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: 600 Sq. Ft. of First Floor: _
Cost of Construction: $ 25,000 Utilities: —Sewer _Septic
Windows/Doors
V"Roof Pitch
Building Height:
OWNER/LESSEE;
`CONTRACTOR: ,
Name Cichocki, Thomas
Name: Ronald Kromhout
Address:5009 Paleo Pines Circle
Company: Ronald Kromhout General Contractor, Inc.
City: Fort Pierce State: _
Zip Code: 34951 Fax:
Phone No.772-203-8957
Address:4500 5th PI. SW
City: Vero Beach State: FL
Zip Code: 32968 Fax: 772-217-2694 .
Phone No 772-473-4597
E-Mail: tomandgina54@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail kromhoutron@gmail.com
State or County License CGC 023856
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUP.PLEMENTALCONSTRUCTION LIEN LAW INFORMATIQN
DESIGNER/ENGINEER: _
Name•EdwardRoske seaside Engineers
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
_ Not Applicable
Address: alas Soth a
City: VmBeacn
Zip: 32ae7 Phone n2-xo2-aooa
State: FL
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
Name:
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 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 YOUR PAYINI
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED' ANI
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. W YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
RIu "t'�
Er-+«
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI�� to °
STATE OF FLORIDA
COUNTY OF •
COUNTY OFlblen�sr
The forgoing Instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this `� day of Sk o 20A by
this ism day of 20_ by
O •N 1%1. k T 0' N%o0-1V
Ronald Kromhout
Name of person making statement.
Name of person making statement.
Personally. Known OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced "b
Produced
(Signature of Notaryblic- StEO(yf JS
(Signature of Notary Public- 51alt of Florida I
Commission No. o te,2azu
° Decein�
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Rev, Z/i/19