HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `� Permit Number:
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FRECE7IVEDBuilding Permit Applicatio ?.018Planning and Development Services
Building and Code Regulation Division Permitkinq
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: 5842 Travelers Way Fort Pierce FL 34982
Legal Description:
Property Tax ID#: 3410-503-0123-00070 Lot No.
Site Plan Name: Block No.
Project Name: McKenzie
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK j
Remove existing tub and install a new walk in tub no tile or drywall work being done
CONSTRUCTION INFORMATION ry
r
Additional work to be ne orme under this permit-check a appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
❑Electric Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
11
Cost of Construction:$ 1700.00 UtilitiesInSewer❑Septic Building Height:
OWNER/LESSEE {CONTRACTOR
Name Dorothy McKenzie Name: Michael Coleman
Address:5842 Travelers Way Company: Prefab Plumbing inc
City: Fort Pierce State:FL Address: 1100 Carr st
Zip Code: 34982 Fax: City: Palatka State:FL
Phone No.772 466-1675 Zip Code: 32177 Fax:
E-Mail: Phone No. 386 546-7643
Fill in fee simple Title Holder on next page(if different E-Mail: mgc1980@gmail.com
from the Owner listed above) State or County License: CFC043003
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL.CONSTRUCTION-LIEN•LAW INFORMATION 3
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:Dorothy McKenzie Name:Michael Coleman
Address:5842 Travelers Way Fort Pierce FL 34982 Address: 5842 Travelers Way
City: Fort Pierce State: City: Pataft State:
Zip. Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:i,00 c—t 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 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 our Notice of Commencement.
d��G� 622u�•�Signature of of Owner/ ssee/Contractor as Agent f Owner Signature of Contractor/License Holder
STATE OF FLO STATE OF
COUNTY OF`ISS LL 11p� COUNTY OF FLORID , G�yq2� -
The forgo' g instrument was acknowledged b fore me The fo�rPPoing instrument was acknowledged before me
this�ay of 2Q(S y this May of -T/G .20 by
TC2&,T\lw M ��& -7-7 /6' — M/(ym t&- d
Name of person making statement Name of person making statement
Personally Known�/OR Produced Identification Personall own OR Produced Identification
Type of Identification Type o Identification
Produc Prod ed L�
Q
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(Signatu f da (Signat ic-State of Florida)
l� KATHRYN P CIrIER ;�'` -4`_ KATHRYN POCKE;?
Commission }; :`= My C ISSION�VIC'6 Commis ici�i N�r,GO T 422
� 49422 F: 4B
EXPIRES November 21,2020 y,'toaFC�Q4 EXPIRES November 21,2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17