HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development9ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce FL 34982 .� /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential �4,
PERMIT APPLICATION FOR: Plumbing ❑ III
PROPOSED IMPROVEMENT LOCATION:
Address: 13509 WAX MYRTLE PALM CITY, FL 34990
Legal Description: HARBOUR RIDGE
Property Tax ID #: 4436$01-0023-000-3
Site Plan Name: W. LAMBERT
Project Name:
Setbacks Front Back:
Right Side:
Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: III
40 GAL ELEC WATER HEATER REPLACEMENT
CONSTRUCTION INFORMATION: III
U Gas Tank LJGas Piping
OPlumbing ❑Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:$ 1237
Shutters ❑I Windows/Doors
I�J
Generator IRoof = Roof pitch
SFt. of First Floor: _
Utilities: Sewer ❑Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name WILLIAM LAMBERT
Name: DIMITREBOBEV
Address: 13509 WAX MYRTLE
Company: FLORIDA DELTA MECHANICAL
City: PALM CITY State: FL
Address: 2716 BROADWAY CENTER BLVD
Zip Code: 34890 Fax:
City: BRANDON State:FL
Phone No.772-340-3436
Zip Code: 33510 Fax: 866-219-0729
E -Mail:
Phone No. 866-219-0880
Fill in fee simple Title Holder on next page ( if different
E -Mail: FLPERMITS@DELTAMECHANICAL.COM
from the Owner listed above)
State or County License: GFC1425917
If value of construction is $2500 or more, a
NTAL CONSTRUCTION LIEN LAW INFORMATION:
ult wit lender or an attorney before
:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
rDESIGNER/ENGINE—ER:
iJe/Z!ob1,fd6tor
Address:
Phone
State: _
City:
Zip: Phone:TITLE
State:_
HOLDER:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
this day ofYY11�r
Address:
✓
City:
Name of perso making sta eent
m
Personally Known OR Produced Identification
City:
_
Type of Identification
Zip: Phone:
duced
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 Assooation 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
b f th f'
ore a Irst I
e nspection. If you Intend to obtain financing, c
ult wit lender or an attorney before
com in w ;;Ic or recording our Notice of Commencem nt.
r
iJe/Z!ob1,fd6tor
Signa re of Own as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDfr-I �jIlr•
STATE OF FLORIDA � � II
COUNTYOF `—`1', 4l�
COUNTYOF X161
The forgoing instr m nt was acknowledged before me
re me
The forgoing inst1��
h , day of( 20Ayby
this day ofYY11�r
e. v
✓
Name of erso makin statement
Personally Knownp= OR Produced Identification
Name of perso making sta eent
m
Personally Known OR Produced Identification
Type of Identification
_
Type of Identification
oduced
duced
gnature of N
(Signature of to
(;"'A "4p, SHLEY OLE ZIEGENGEIST
>> *M Ag NICOIE �EGENGEIST
Commission No.
-• -•11 OMMIS&Rl4FF12W12
Commission Na. VCOMMIif$0{�kFFt20712
'..1o�n... EXPIRES May 7, 2018'•'?a,
, f EXPIRES May 1, 201 O
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