HomeMy WebLinkAboutBuilding Permit Application Dec 07 17,09:38a Jensen Beach Plumbing 7722256779 p•1
{ ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED W1
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Date:
Permit Number: ( I"�- �Z �Z►
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Building Permit Application ,
Planning and Devefopment Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
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Phone:`Q72)462-1553 Fax:(772)462-2578 Commercial ' Residentlall XX
PERMIT APPLICATION FOR: A
To Select from dro box, click arrow at;the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1728 Pondberry Lane
Legal Description- LAKE L UCIE ESTATES PLAT NO.ONE LOT 146(OR 1375-2061) I; !
PropertyTax iD#: Parcel 1D:3426-703-0160-000-4 Lot No. 146
I Site Plan Name: Black No.
Project Name:
5-Setbacks Front Back: Right Side: Left Side: f'
DETAILED DESCRIPTION OF WORK:
Replace existing hot& cold water lines with Uponor water lines I;
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CONSTRUCTION INFORMATION:
Additional work to bgpertormed under this permit—check all t=appy:
F1HVAC Gas Tank ❑Gas Piping (�_�Shutters i Windows/Doors
F]Electric LY 1 Plumbing ❑Sprinklers U Generator Roof; Roof pitch
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Total Sq.Ft of Construction: Sq.Ft.of First Floor: {„ i
Cost of Construction:$ 4,500.00 Utilities:OSewer F Septic �,Building Height:
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OWNE,Ii/LESSEE: CONTRACTOR: I
Name Lean&Patricia Warren Name: Lonnie J Culbertson i•'
Address:1728 Pondbeny Lane Company: Jensen Beach Plumbing;Inc.
City: Port St Lucie State: FL Address: 1086 NE Industrial;Blvd I
Zip Cade: 34952 Fax: City: Jensen Beach', j I State:FL
Phone No.772-979-4308 Zip Code: 34957 I'' Fax:,772-225-6779
E-Mail:msbossy@bellsouth.net Phone Na. 772-225;6600 ;
Fill in fee simple Title Holder on next page(if different E-Mail:jbplumbing@bellsouth,net
from the Owner listed above) State or County License: RF110673721SLC 24654
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. i
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Dec 0717,09:38a Jensen Beach Plumbing 77222567719 p.2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: :' Not Applicable
Name:Leon&Patricia warmn Name:Lonnie)Culbertson I
Add ress: 1728inondberryLane Address: 1728 Pondberry Lane
City.- Port StLucie State: City: Jensen Beach I State:
Zip: Phone- Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable 13ONDING COMPANY: !Not Applicable
i Name-.' Name:
Address:1086 NE Industrial BW Address:
City: City:
Zip: Phone: Zip: Phone: I
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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and"coveriants that ma�,restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for ahy restrictions which may apply.
I Inconsideration 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
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WARNING TO OWNER:Your failure to Record a Notice of Commencement mayI result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded an'd posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with 16nder or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Licenk Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF h8EM14 :
The forgoing instrument was acknowledged before me Theing instrument was adknowl6dged before me
this day of 204 by this fRoday of 1)t1rttMb-e1- ,120M by
LCAdV� CA-A kbe -,,on
Name of person making statement Name of persorimakibg statement
Personally Known OR Produced Identification Personally Known V' OR Produceld Identification
Type of Identification Type of Identification
Produced Produced
e
is
(Signature of Notary Public-State of Florida} Si azure of tory Public- ;q •F,Iarid��C�yN>F WILSCI
MISSICt4#pFI5917
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Commission No. (Seal} Commission 811Commission No.N 1
S november ,2
1" ce,c
t4 Flocidallotaryservia"I
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE i
RECEIVED
DATE j
COMPLETED
Rev.8/2/17