HomeMy WebLinkAboutBuilding Permit Application .ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
i
Date: Permit Number:
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 LOCATIQN:. AM 1W
,
Address: 4904 Pinetree Drive
Legal Description: Indian River Estates-Unit 1-BLK 3 Lots 5 and 6(map34/02N)(OR 1958-590
Property Tax ID#: 3402-602-0087-000-4 Lot No.5&6
Site Plan Name: Block No. 3
Project Name:
Setbacks Front Back: Right Side: Left Side:
�'t.^
DETAILED DESCRIPTION:OF WORK
' � I
Hook up from house to County water meter
i
I
CONSTRUCTION INFORMATION. "
Additional work toe e ormed under tis permit—checkallappy:
HVAC 11 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ZPlumbing Sprinklers E Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
I
Cost of Construction:$ Utilities. _Sewer Septic Building Height:
OUI1N_ER%LESS`EE:" �T ACTOR ';
CO N.TR
Name Gail&Renee Scott Name:
-Address:4904 Pinetree Drive Company:
City. Fort Pierce State:FL Address:
Zip Code: 34982 Fax: City: State:
I
Phone No.9542148539 Zip Code: Fax:
E-Mail:scootybobl@comcast.net Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
i
SUPPLEMENTAL CC?NSTgRIUCTIONLIEN LAW INF,`ORMATIbNX =j' k ,
r
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:;�' _Not Applicable
N a me:Gail&Renee Scott Name:
Address:4904 Pinetree Drive Address: 4904 Pinetree Drive
City: Fort Pierce State: FI City: State:
Zip: 34982 Phone 9542148539 Zip: Phone: I
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 permit t do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
I
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-vroom 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
commence Work or recordingour Notice of Commencement.
/'
Signature of Owner/Lessee/Contractor as Allent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 3y+1U 6: COUNTY OF
The forgoing instruq1tnJ was acknowledged before me The forgoing instrument was'acknowledged before me
this I day of 20L by this day-of '20 by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known I OR Produced Identification
Type of Identific0ion Type of Identification'
Pr ucedL 1 Produced i
I
� I
igna ure of Notary Public-Stat f Florida) (Signature of Notary Public-State of;Florida)
Commission No. L,($e81,)NA INGRAM Commission No. (Seal)
MOT.,
� Notary Public-State of Florida
My Comm.Expires Dec 20,2010-1'l2 A!1
'°����'•� rough daJ ,e tar s
REVIEWS F �:P PLANS VEGETATION 'SEA TURTLE MANGROVE
COUNTER" ' REVIEW' REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
j RECEIVED 11
DATE
COMPLETED
Rev. 8/2/17 i
i