HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR: Plumbing
PROPOSED.IMPROVEMENT.LOCATION:
I +Lone-
Legal
,,
Address: "1n /�6O5 ✓�1yai Q. {! l�_one
Legal Description:TInQ S0_+ e try f , —I ho_A
Property Tax ID#: 3SZZ. JQZ.— OCZ-7_ 000-4 Lot No. ZO
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i � � „1
DETAILED DESCRIPTION OF WORK: as
0�1 UJ( �e v lq eCQ I u d"e CCH 5o 90-I 1
CONSTRUCTION INFORMATION:
I
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers ElGenerator `E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ � Utilities:DSewer Septic Building He
OWNER/LESSEE: `'CONTRACTOR!,r9
d
Name COY C -:SClrneS ' I Jov Icn Name: A11w i( 1rnnr)
Address:` 6c96 A v it! [nine- Company: anvice Americo
Ca
City: C65 ' . State:_ Address: P155 tt)
Zip Code: LAC-] e)(p C�Fax: City: T:1 L�L.Ide)' G��Q State_fi (
Phone No. 1 1� -`I" 59 - 9187 7— Zip Code: 33 1 Fax: q5�_q-1-7-3EQJ
E-Mail: Phone No. C151 e1q- 110 0
Fill in fee simple Title Holder on next page (if different E-Mail: LDLy(n lU�,l i�Q.�1/ICeQ.Vl(a,C
from the Owner listed above) State or County Licen e: C, CcD5 r A0(-SL
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
r;;a
SUPPLEMENTAL CONSTRUCTION`LIEN LAW INFORMATION;: WJ
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:
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 thepermit 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 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
commenci ork or regording your Notice of Commencement.
/Zz / ) s
Sign re of Owner/Lessee/Contractor as Agent for Owner `SignatGre f Contractor/Lice sn e�Horbr
ST TE OF FLORIDA STATE OF FLORIDA
COUNTY OF /gl� Py�� COUNTY OF rl �y
The forgoing instrument was acknowledged before me The forgs�ing instr nt was acknowledged before me
thisg/ day of /`-e Q 20 L4by this Z/ day of 20!7 by
40 S l= GGAR k- I nen
(Name of person ack Wedging) (N me o p irson ackn,wledging)
(Signature f N�ry Public-State of Florida) (Signa No rylPublic-State of Florida)
Persondlly Know Produced Identification�L' Pe ovally Kn w Y Po R Prod@dJ0@rFti�tion
Type of Identific ttFflaa Type o entific PdFlorida
MY KRIS CAINPBELL
N c Commission#GG 33870
Commission No a'.•= CGMMIS Ll�F1 Commission No. 1- Expires& b20
32553
(ao��asa-ossa "RES June 1S,2018
F .
e"nce.com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS