HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S� �� Permit Number:
RECEIVrD AIR 03 7..017
S,moi:• I'J
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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: To Select from dropbox, click arrow at the end of line `� b•
PROPOSED 1IMPROVEMENT LOCATION:
Address: 10680 South Ocean Drive Apt 1201,Jensen Beach, Florida 34957
Legal Description: Island Crest Condominium Unit 1201 and Undiv Share in Common Elements
Property Tax ID#: 4511-516-0118-000-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install an acrylic shower base and a new shower valve in the guest bathroom.
CONSTRUCTION INFORMATION:
Additional work toe nertormed under tispermit—check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing []Sprinklers �Generator 11 Roof F Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1,000 Utilities:[]Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Bernice Zahn Name: Greg R.Bassett
Address:10680 S. Ocean Dr. Unit 1201 Company: Wellworth Plumbing LLC
City: Jensen Beach State:FI Address: 1016 Antilles Ave
Zip Code: 34957 Fax: City: Fort Pierce State:FI
Phone No.772-229-8964 Zip Code: 34982 Fax:
E-Mail:N/A Phone No. 772-579-2462
Fill in fee simple Title Holder on next page(if different E-Mail: wellworthplumbingllc@gmailc.com
from the Owner listed above) State or County License: CFC1428815
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 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 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 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
commencing work or recording our Notice of Commencement.
s
Signature o wner/Lessee/Contractor as Agent for Owner Sihnature OT ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF 'I �.ve�� COUNTY OF _<k, -1,yeo-Q,
The forgoing instr went was acknowledged-before me The forgoing instrument was acknowledged before me
this�day of Tl 20 by this day of T� 20 by
(Name of person ack owledging) (Name of per n ackn wledging)
(Signature of Notary Public-State of Florida) (Signature of Notary PuRic-State of Florida)
Personally Known OR Prod ced Ide t' Personally Known
Type of Identification Pr HENS Type of Identificati d �D�AN� MMIE G N -1'
• ��a;,w a ,: 3 r •,tc M COMMISSION#GG 022023
MY COMMISSION#GG 022023 .o EXPIRES:D
Commission No. =, &*a�S:December16,2o20 Commission No. 16,2020
Bonded Thru Notary Public Underwriters ded1111ru Notary Public Undervrn':en: f&
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS