HomeMy WebLinkAboutBuilding Permit Application Sep 2717,03:33p Jensen Beach Plumbing 7722256779 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:13% 1 Permit Number:
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RECEIVSD SEP 2 7 2017
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 X
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address:_ I ar , t:)r
+
1 n
Le al Description: �fwtl;, r 'IJ
Property Tax ID#: —15 �a ' O a 6 Cf d G _a Lot No.
Site Plan Name: ` Block No.
V�
Project Name: toAll z U)T Rav(.'
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
AdclFtional work toe e orme under t —checkispermit a appy:
OHVAC 0-Gas Tank F]Gas Piping Q_Shutters Windows/Doors
Electric �lurnbing Sprinklers I Generator 0 Roof Roof pitch
Total Sq.Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction:$ �o 3 • Cie, Utilities:OSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ksk ' �G ({ c� Name:
Address: 10-70t CSC " r Company: g.ri r) PYceicA, trnbdn
City: :Z2iG-e:a F;,ec�c. State: j—L Address: 72 �v5h-,:4- f 13l v1_
Zip Code: �'S`7 Fax: City: T&iv cr) 13c e CA State:
Phone No. Zip Code: 294-c%.S"7 Fax:7J.2-
E-Mail: Phone No. 772—
Fill in fee simple Title Holder on next page I if different E-Mail:Tt�I,,+vii,•�� �.,ix'llSC�'v� r7
from the Owner listed above) State or County nse: F I ao!
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Sep 2717,03:34p Jensen Beach Plumbing 7722256779 p.3
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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permitto do the work and installation as indicated.
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 Horne 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
cornmencing work or recordins your Notice of Commencement.
Sighature of Owner essee/Contractor as Agent for Owner Eignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF )DL-' c P-4zLO COUNTY OF YY1w2Ln _
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�l day of �z r>'^,r�l�r: 20_ by this-31 day of Sal, `�r 2011 by
1---6I'1 r'd_c C A�l�)�}2 �fl �_ r,rl►1►�_ �A 1c t�T (1
Name of person making statement Name of person making statement
Personally Known !�C OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
y
Si nature of IlZtary Public-St JAC�Yty -V41L50r4 (7, ature of tary Publi
_ N _o. A �: JACL.YIV F WILSOIN
Commission No. f t �. thY( � Vem�er 6.201 ission No. PhY�S�1 SSIOPJ#FF159. 7
},r yo4= p14,ES 10 ryserv1Ce.com F I��'77 'N',;' ",_" EXPIRES November 8,20'
` Cor P•.`' .,r.or .'.%
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L407) 98 FloridallotaryService.roro
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17