HomeMy WebLinkAboutSLC permit request 4610 Myrtle drPlanning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Plumbing
Residential X
Address: 4610 Myrtle Drive, Ft. Pierce, 34982
Legal Description: INDIAN RIVER ESTATES -UNIT 07- BLK 40 LOT 5 (MAP 34/02N) (OR 3828-292)
Property Tax ID #: 3402-608-0080-000-3
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Installed shower valve and move drain 6" in master bath
HVAC F]Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 725
Sprinklers
"Shutters
0 Generator
Sq. Ft. of First Floor: _
Utilities: Sewer 11Septic
Name Debra J Keseric
Address: 4610 Myrtle DR
City: Fort Pierce," State: FL
Zip Code: 34982 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No._
Block No.
Windows/Doors
Roof Roof pitch
Building Height:
Name: Dale Hammond
Company: For Hire Plumbing
Address: P O Nox 1355
°Qnsentea -� State: FI
Zip Code: 34957 Fax:
Phone No. 772-342-8677
E -Mail: forhimplumbing@aol.com
State or County License: CFC1428915
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:`
DESIGNER/ENGINEER: _ Not Applicable
N a m e: Debra J Keseric
MORTGAGE COMPANY: _ Not Applicable
N a m e: Dale Hammond
Address: 4610 Myrtle Drive, Ft. Pierce, 34982
Address: 4610 Myrtle DR
City: Fort Pierce, State:
Zip: Phone
City: Jensen Beach State:
"Zip: Phone:
FEE SIMPLE TITLE BOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address: P 0 Nox 1355
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 thepermit 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 youA�tend to obtain financing, consult with lender or an attorney before
commencina work or recordinghoMr Notice of Commencement. n
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE
OF FLORIDA STATE OF •' •i
COUNTYOF • OF
The for oing instrument was acknowledged before me
this day of A 6 L 20/1b
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P �rsolye Known OR Produced Identification
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Produced
(Signature of NotaryPt
Commission No.`—°°
WALTER D PAYNE II
NA1191] ublic - State of Flt
Commission # GG 244E
Ay Comm, Expires Aug 25„
REVIEWS FRO
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
REVIEW
The forgoing instrument was acknowledged before me
this day ofr� 20 by
an7' person aking statement
Personally Kno OR Produced Identification
Produced
nature of Notary Pu
I( mission No.
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P NS VEGETATIC
REVIEW REVIEW
State of rlorida )
XRPLa- (Se Y LTER D PAYNE it
Notary ublic • State of F
•5 Commission # GG 244
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