HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //
Date: Permit Number: f IDS • 0��T�
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: z
;,r. ,
Address: 11931 S. INDIAN RIVER DRIVE, JENSEN BEACH FL 34947
Legal Description: PARCEL#3532-802-0006-000-7
Property Tax ID#: ACC#116416 Lot No.
Site Plan Name: Block No.
Project Name: ALEXA DIX
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF ' O' -R'K, 1
P
REMOVE CAST IRON PIPING AND REPLACE WITH PVC SCH 40
'CONSTRUCTI:O;N:INFORIVIATION: } ��
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Additional work to be nertormed under this permit-check all applyIn
:
HVAC Gas TankDGas Piping _Shutters Windows/Doors
Electric 0✓ Plumbing Sprinklers E]Generator FlRoof Roof pitch
Total Sq. Ft of Construction: 4100 SQ FT SFt.of First Floor:
Cost of Construction:$ 5000.00 Utilities:nSewer Septic Building Height:
OWNER/LESSEE: ` CONTRACTOR
Name ALexp, Name: MARK WHITE
Address: /1) _ Company: AMERI-TECH PLUMBING, INC
City:,.o,r� 1�S'EA) BO-14 t'- ?�9!�r�State:.>! Address: 3526 SW ARMELLINI AVENUE
Zip Code: Fax: City: PALM CITY State:FL
Phone No. Zip Code: 34990 Fax: 7728794477
E-Mail: Phone No. 7728790754
Fill in fee simple Title Holder on next page(if different E-Mail: info@ameritechplumbing.com
from the Owner listed above) State or County License: CFC-058027
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL:CONSTRUCTION`LIEN LAW IN'FORMATION�t ' }
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 the jobsite
before the first ins ection. If yo intend to obtain financing, consult wit e r an atto ey before
commencing or cordin our Notice of Commencement
s
Signature of Ow see/Contrac or as Agent for Owner Tignature of Cot ice a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L. _ COUNTY OF MARTIN
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20)1 by this 22 day of MAY 20 by
(Name`of person acknowledging) (Name of person acknowledging)
( ' atu a of Notary Public-Sqate of Florida) _F1 9 a ure oN ot'a�7 Public-S to of Florida)
Personally Known OR Produced Identification Personally Known x OR Produced Identification
Ty a of Identification Produced Type of Identificatio
�' 1�.�3Z(� .��IcL.las• t°`'p�p`'�CA MARS A
SESSER
Commission No. (Seal) Commission No. FF1 X063 AA
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oF..""..' EXPIRES October 22,201a
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS