HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development 5ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential XXX
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 5214 Buchanan Dr
Legal Description: INDIAN RIVER ESTATES -UNIT 1- BLK4 LOTS 17 AND 18 (MAP 34/025) (OR 3820-775-13830-1658)
Property Tax ID #: 3402-602-0123-000-9
Site Pian Name:
Project Name:
Setbacks Front Back:
Connect FPUA water meter to house
Right Side
Witional work to bM
rtormed uncter tnis permit— check a
HVAC Gas Tank E]Gas Piping
®Electric Z✓ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1,225.00
Left Side:
L._J Shutters
E] Generator
S Ft. of First Floor: _
Utilities:Sewer Septic
Lot No.,
Block No-
Windows/Doors
Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Lester Workinger
Address: 5722 NW 80th Ter
Name: Reed Sudderkh
Company: CRS Plumbing
City: Parkland State:Fid
Zip Code: 33067 Fax:
Phone No_ 678-570-2822
Address: P.O. Box 12755
City: Fort Pierce State: FL
Zip Code: 34979 Fax: 772-460-7774
Phone No. 772466-7763
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: crsplumbing@bellsouth.net
State or County License: CFC1426853
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address
City:
City:
Zip: Phone:
Zip: Phone:
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.
_ Sig re of Owner// Lessee/Agent
STATE OF FLORIDA
COUNTY OF s- --
The forgoing instrument was acknowledged before me
this 6 day of AUG , 20 8—by
Edward D. Jendon
(Name of person acknowledging )
�J
(Signature of Notary Pu li - State of Florida )
Personally Know
Type of ldentificNf,—
E-PiMS
uct�„ ni;
Edward D Jendon
Commission No.` MY Commissior�78514
65118!
Revised 07/15/2014
S
Sign6tdrk of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF stLu.e
The forgoing instrument was acknowledged before me
this 6 day of AQ; 20 18 by
Edward D. Jendon
(Name of person acknowledging )
(Sknature of Notary Pu F - State of Florida j
Personally Known ✓ x'
Type of Identification P �i9f9fy Public $fateof Fkxidai
v . 011" Tendon
a}
�9f11HI
Commission No. ;,knob El Cafn 2 178514
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