HomeMy WebLinkAboutBuilding Permit Application Jun 151702:00p Jensen Beach Plumbing 772-225 779
p.2
ALL APPILICABE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
GBLE I7 MUST r7 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 X
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 7901 Black Tern Dr,Port St Wee, FL 34952
Legal Description: Eagle's retreat at Savanna Club(PB 42-24)Blk 54 Lot 9(or 2893-1533)
Property tax. 10#: 3424-701-0025-000-4 Lot No.
Site Plan Name. Block No. 54
Project Name: Cuthriell,Dona
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Supply&install new 30 gallon medium hot water heater in closet.
coNsTRucTION INFORMATION:
Additional work to be nerformed under this permit—check all apply:
F]HVAC
Gas Tank F]Gas Piping Shutters Windows/Doors
Plumbing Sprinklers Generator
Electric 17 Roof' Roof pitch
Total Sq.Ft of Construction: So-Ft.of First Floor;
Cost of Construction:$ 1000.00 Utilities:Q Sewer 0 Septic ,Building Height:
-OWNER/LESSEE: CONTRACTOR:
Name Dona W Cuthriell Name: Lonnie Culbertson
Address:7901 Black Tern Dr Company: Jensen Beach Plumbing,
City: Port St Lucie State:FL Address: 11086 NE Industrial I Blvd
Zip Code" 34952 Fax: City: Jensen Beach,— State.FL
Phone No.772-233-3061 Zip Code: 34957
Fax: 772-225-6776
E-Mail: Phone No. 772-2256600
Fill in feesimple Title Holder on next page(if different E-Mail: Tiffany-JBPiumbing@Bellsouth.net
from the Owner listed above) State or County License. State:RF1 1067372,County:24654
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is reclitired.
Jun 1517 02:00p Jensen Beach Plumbing 772-225=6779 p.3
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: r x Not Applicable
Name: Name:
Address: Address:
City: State: City: ! State:
Zip: Phone: Zip: Phone:
I
FEE SIMPLE TITLEHOLDER: x Not Applicable BONDING COMPANY: x 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 holderlto build,the subjectstructure
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,l 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 yourlpaying 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.
I
_ s
Signature of Owner/Lessee/Contractor as Agent for Owner 4iknature of Con cfor/License Holder
I
STATE OF FLORIDA STATE OF FLORIDA,
COUNTY OF COUNTY OFr �
i'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_day of 20 ___by this j.,5' day of QIP Q ! 20 17 by
(Name of person acknowledging) (Name of person acknowledging)
r
r � '
(Signature of Notary Public-State of Florida) Signatur f Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of identification Produced
Commission No. (Seal) Commission No. Ft-159-272 *^-° (Sf &Lys F W1LS0
My CGEdNIISSION#FF159
OF it
Revised 07/15/2014 i(0,07)368.0153 FjcAdallotaryService.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION I, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INIT1Al5 '
i n