HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
e-- Building Permit Application
Planning and Development Services
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: 9OU5 Houndslake Court
Legal Description: MAIDSTONE (PB 43-11) LOT 111 (OR 3668-1158)
Property Tax ID #: 3322-505-0120-000-5
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Replace existing 50 gal electric water heater in garage
Lot No. 111
Block No.
CONSTRUCTION INFORMATION:
Additional work to bnr orme un er t is permit — c ec a t atapp y:
HVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers F Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 900.00
S Ft. of First Floor: _
Utilities:0Sewer 0Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Donald A Glies &Christine M Glies
Name:
Address: 9005 Houndslake CT
Company: Mr Rooter of the Treasure Coast
City: Port St Lucie State: FL
Zip Code: 34986 Fax:
Phone No.
Address: 534 NW Mercantile PI, Suite 119
City: Port t Lucie State: FL
Zip Code: 34986 Fax:
Phone No. (772)236-7300
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: james.mrrooter@gmail.com
State or County License: CFC1425604
- ��••�•• ��••�•• •� �� ,�� W• 111U1 C, d nr-a.vnvw ivosice or 1-ommencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: Donald A Glies &Christine M Glies
Address: 9005 Houndslake Court
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 9005 Houndslake CT
City: Port St Lucie—State:
Zip: Phone
City: Portt Lucie State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: 534 NW Mercantile PI, Suite 119
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
City:
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 your Notice of Commencement.
Signifure of Owner/ Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holder
STATE OF FLORII?A STATE OF FLORI A
COUNTY OF 40 �i COUNTY OF �_-
The forgoing instrument was acknowledged before me
this\ day of 20ij: by
Name of persorymaking statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State
Commission NoJ—�9 `117G0'S
REVIEWSI FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ZONING
REVIEW
The forgoing instr ment was acknowledged before me
this cf day of 20by
Name of person making statement
Personally Known _� OR Produced Identification
Type of Identification
Produced
-&;,t^" ,'_
1gn a of Notary Public -
KRISTEN L BE SLEY
Notary Public - Sta a @�Ft{q� on No. C4 170'0�
Commission #f F 970405
My Comm. Expires ar 10. 2020
SUPERVISORI PLANS I VEGETATION I SEA TURTLE
REVIEW REVIEW REVIEW REVIEW
RK151 1114 L D[nat-
Notary Public - State of
ealpommission M FF 97
14'Comm. Expires Mar
MANGROVE
REVIEW