HomeMy WebLinkAboutBuilding Permit ApplictionALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11- 1 --7 - I-- Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Aven ue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPR€�VEMENT LOCATION:
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Address: � t —FW
Legal Description: r) nuy .� Q_C � �JI�Q y-0; - 6ph qYl J L J y
Property Tax ID##: j,>IZ -565-o)18 --000- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit –check all that apply:
HVAC El Gas Tank ❑Gas Piping 1:1 Shutters Windows/doors
Electric Z Plumbing ❑Sprinklers E Generator Roof
Total Sq. Ft of Construction: S�Ft. of First Floor:
Cost of Construction: $ I , � � IN-\ Utilities: —Sewer Septic Building Height:
OWNFRAESSEE: 9"", Name (IIbl'I� 1k Address: 11 7 -
City: '�Fby+ Via- State: 1_17L_
Zip Code: '�WQ� 1 Fax:
Phone No. n4 ni " Z-5 I -
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: CRAIG MOBLEY
Company: SOUTHERN PLUMBING, INC___
Address: 406943RD AVENUE
City: VERO BEACH State: FL
Zip Code: 32950 Fax: 772-978-9843
Phone No. 772-564-6980
E -Mail: SOUTHERNPLUMBING@AOL.COM
State or County License: RFOO67100
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Dame: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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 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
improverAnt5 to your property. A Notice of Commencement mus14)e recorded and posted on the jobsite
before qiqffirst inspection. if you intend to obtain financing, con with lender or an attorney before
com n ng work or recording your Notice of Commencemen 1
Late
s
Siwner/ ssee/Agent Signat e Cotractor License Holder
STATE OF FLORIDA STAT OF FLORID T
COUNTY OF INDIAN RIVER COUN EY OF INDIAN RIVER
The for oing instrument was acknowledged before me
this I'/ day of Y 20 I_Jby
(Name of persoqZ ac nowledging )
(Signa)lre of Notary 64blit- State f Florida)
17 11
Personally Known V-' OR Produced Identification
Type of Identification Produced
The forgoing instrument was acknowledged before me
this /I? day of -TU t y 20 0 by
OVU � �[ Cy
(Name of per n acknowledging)
(Signat re !f_Noytaryp
rc- State o- Florida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.,�.`,'' ' f�1�i'�L.Y Commission No.
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ReVI&OC 07/15/2014 °'„ EXPIRES June 18, 2039 1m4 EXPIRES June 18, 2(119
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