HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: –1 T_ Permit Number:
Building Permit Application
Planning and DevelopmentServices
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:
Address:
Description:,
Property Tax ID#: – } Lot No.
Site Plan dame: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
T,kplaa . 3c) GasQ U-)
CONSTRUCTION INFORMATION:
Additional work to eer o
rmed under this permit –check all that appy:
HVAC Gas Tank I]Gas Piping Shutters Windows/Boors
Electric �✓ Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Name_.1`--H 1 H
SFt. of First Floor:
Utilities:Sewer oSep ' Building Height:
Address
City: State:(.
Zip Code: Fax: —
Phone No. Z ~ Lto
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: CRAIG MOY r
Company: SOUTHERN PLUVPING, INC
Address: 4069 43RD AVENUE
City: VERO BEACH State: FL
Zip Code: 32060 Fax: 772-078-9843
Phone No. 772-064-6980
E -Mail: SOUTHERNPLUMBING@AOL.COM
State or County License: RF0067100
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name: _
Address:
City: _
Zip;
NGINEER: x Not App
Phone:
State:
�14J ilvi'UK)1IIA I I,UN
le ` MORTGAGE COMPANY: X Not Applicable
Name:
Address:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
Address:
City:
,Zip: Phone:
City: State:
Zip: Phone:
BONDING COMPANY: x Not Applicable
Name:
Add ress:
City:
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, 1 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, waifs, 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
improvemeDo to your property. A Notice of Commencement m be recorded and posted on the jobsite
before th i t inspection. If you intend to obtain financing, co s t with lender or an attorney before
Cpmm Ci work r recordingour Notice of Commencem t.
of jDwner/
STATE OF FLORIDA
COUNTY OF INDIAN RIVER
Agent
The for oing instrument was acknowledged before me
this 74 day of 6IVr l 1 20 12by
of gbntractor}License Ho
STATE OF FLORIDA:
COUNTY CIF INDIAN RIVER
The forgoing instrument was acknowledged before me
this �g day of _P&L. 20 t_L by
� Gr..l i1'?9ihJ
(Name of pe rsocjcknowledging ) J (Name of pers n cknowledging )
(Signature/of Notary blit- Stat -(Lf Florida }
Personally Known V"— OR Produced Identification
Type of Identification Produced
Commission No. L
Revised 07/15/20141. tn4'7'ahe
REVIEWS FRONT
COUNTER
DATE
COMPLETE
INITIALS
gL
(Signatu of Notary P Ic- State of Porida }
Personally Known ✓ OR Produced Identification
Type of Identification Produced
'7
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Commission No._._(a.,
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EXPIRES June 18, 2019
EXPIRES June 18, 2019
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