HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: June 27, 2018 Permit Number:
J94 AN'
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 XX
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 1313 Midway Rd. Ft. Pierce
Legal Description: White City Block 73
Property Tax ID#: 3404-501-0428-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace hall bathroom single handle shower valve (like: for like)
CONSTRUCTION INFORMATION:
Additional work to e e orme under this —checkpermit a t a apply:
IIHVAC E] Gas Tank L]Gas Piping _Shutters []Windows/Doors
11 Electric Z Plumbing O Sprinklers Generator F-1 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft,of First Floor:
Cost of Construction:$ 550.00 Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1313 Midway LLC Name: Gary W.Zanello
Address:13100 Park Blvd Ste B Company: Port St Lucie Plumbing
City: Seminole State:FL Address: 6907 Heritage Dr
Zip Code: 33776 Fax. City: Port St Lucie State:FL
Phone No.727 692-1008 John Zip Code: 34952 Fax: 772 489-9126
E-Mail: Phone No. 772 468-6524
Fill in fee simple Title Holder on next page(if different E-Mail: portstlucieplumbing@gmail.com
from the Owner listed above) State or County License: CFC058025
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIED LAIR! INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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 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 penzit 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 tvt+ice 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 recordin our Notice of Commencement.
1 f-v'�v
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Signa!4'e of Q ner/Lessee/Contractor as Agent for{owner Signatu`r,of Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
G COUNTY OF-- COUNTY OF-- J.
Thes ff7r ping instruTnt was acknowledged before me The forgoing instr� nt was acknovviedged before me
tt r day of ( �3 =20/9 by thls day of P— Zp lv by
Gary W.Zsnalla .Gary%X Zartao
Name of person making statement blame of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
e a
A
(Signature of Notary Public- a ,f_a) (Signature of Notary Pub - rida)
- COMMISSi0N #FFWI
?�. r� COMMISSION #fF901099
Commission No. FF eal)9614U99 EKMAE&:August 25.201 Commi55ion No. FF9otasa _ ((S S:August 25,2019
q�r rt"`,��•` www.AmONNOTARY.CO � �lWW.MrAowy.COM
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Rev.8/2/17