HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:i o-2-U• it Permit Number: �rlT _
- _ RECE1VED
Building Permit Application OCT 2 6 2011
Planning and Development Services PEWA.li IPdG
Building and Code Regulation Division St. Lucie Count;, rL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Plumbing a
PROPOSED IMPROVEMENT LOCATION:
Address: 4901 Grovers rd
Legal Description:
Property Tax ID#: 1313-132-0003-000-1 Lot No.
Site Plan Name: Block No.
Project Name: Priest
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove existing tub and install a new walk in tub no the or drywall work being done
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit-check a appy:
HVAC f]Gas Tank F]Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 1700.00 Utilities:Sewer M Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameEverettPdest Name: Michael Cloeman
Address:4901 Grovers rd Company: Prefab Plumbing inc
City: Fort Pierce State:FL Address: 1100 Carr st
Zip Code: 34951 Fax: City: Palatka State:FL
Phone No.772 466-0374 Zip Code: 32177 Fax:
E-Mail: Phone No. 386 546-7643
Fill in fee simple Title Holder on next page(if different E-Mail: mgc1980@gmail.com
from the Owner listed above) State or County License: CFC043003
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
N am e:Everett Priest N a m e:Michael Cloeman
Add ress:4901 G-- Address: 4901 Groversrd
City: Fort Pierce State: City: Palatka State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:1looca t Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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
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.
CUICZAH�E'
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID!�� STATE OF FLORID
COUNTY OF COUNTY OF
The f Ing instru t wa ack owled _ foa me cknowledg f
this,, dayof 2 �Y re me
th' 'day of 20 by
Name of personMaking statement Name of person_ aking statement
Personally Known �OR Produced Identification Personally Known OR Produced Identification
Type of Identific n Type of Identificat'
Produc d / Produced
O
(Signatu e' ry Nor' ( gnature ofr' E
State of Florida)
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S November 21,202,
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17