HomeMy WebLinkAboutBuilding Permit Application Feb 061711:07a CRS Plumbing 772-460-7774 p.2
ALLAPPUCABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date: 1 Permit Number: 0131Q__d`a�s
RECER'77D FEB 0 71017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2310 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential XXX
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 5903 Tangelo Dr
Legal Description: INDIAN RIVER ESTATES-UNIT-09-BLK 76 LOT 40(MAP 34111S)(OR 776.1388: 1225-359;3842-2303)
Property Tax ID#: 3402-610-0185-000-6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Repair broken water main and shower.
CONSTRUCTION INFORMATION:
Additional work to be ne( Orme under is permit—checka apply:
HVAC LSI Gas Tank ❑Gas Piping Shutters a Windows/Doors
Electric M Plumbing ❑Sprinklers OGenerator
Roof
Total Sq. Ft of Construction: Ft.of First Floor:
Cost of Construction:$ 1150.00 Utilities Sewer 1:1 Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Richard B Sizemore Name: Reed Sudderth
Address:5903 Tangelo Dr Company: CRS Plumbing
City; Fort Pierce State:FIL Address: P.O. Box 12755
Zip Code: 34982 Fax: City: Fort Pierce State:FL
Phone No.772-216-4884 Zip Code: 34979 Fax: 772-460-7774
E-Mail: Phone No. 772466-7763
Fill in fee simple Title Holder on next page(if different E-Mail: crsplumbing@bellsouth.net
from the Owner listed above) State or County License: CFC1426853
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Feb 061711:07a CRS Plumbing 772-460-7774 p.3
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 TITLEHOLDER: ,,,_Nat Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Count 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 consultwrth 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 exemptfrom 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 paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencin work or recording our Notice of Commencement.
-JJS
Si ature of Owner/Lessee/Agent Signa of contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFs—Cm COUNTY OF st—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 3 day of 20 (7—by this .3 day of FCCR 20 17 by
Edward D.Jendon Edward D.Jendon
(Name of person acknowledging) (Name of person acknowledging)
?f-0LZ-4r1J0'Qk�� e46JWU'� -
(Sigrfature of Notary Public-tole
of Florida) ( 'gnature of Notary Pu i State of Florida)
Personal) Known Pro�C eed�Id�ntif a ' Personal) Known uce en
Personally EDWfltf�- y ° EDWARD D JEND
Type of Identification gddiide` 't Type of Identification Pro p,e t
R331uI 1 a 7 '
± ,off r My COMMISSION#'FF124537
Commission No. �: EXPIF 110ay 19,2018 Commission No. ?o�'ri EXPO May 19
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(407)398.0187 FlaridalloteryServlae.com (4071399-051 FlorldeNoteryseNicecom
Revised 07/15/2014
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