HomeMy WebLinkAboutPermit - 5133 Melissa Lane - signed ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s '
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 XXX
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 5133 Melissa Lane
Legal Description: GREEN ACRES-UNIT 3-BLK 6 LOT 2(OR 2613-730)
Property Tax ID#: 1430-702-0042-000-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Connect water line to new water meter
CONSTRUCTION INFORMATION:
n� itiona workto e e orme under this permit—check a apply,
LJHVAC Ei Gas Tank E]Gas Piping _Shutters Windows/Doors
L__.)Electric 0 Plumbing Sprinklers Generator Roof
Total Sc1_ Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1,135.50 Utilities:0Sewer Eleptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Robert Quick Jr Name: Reed Sudderth
Address:2801 Industrial Ave 3 Company: CRS Plumbing
City. Fort Pierce State:FL. Address: P.O. Box 12755
Zip Code: 34946 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34979 Fax: 772-460-7774
E-Mail: Phone No. 772-466-7763
Fill in fee simple Title Holder on next page(if different E-Mail: crspiumbing(§bellsouth_net
from the Owner listed above) State or County License: CFC1426853
tf value of construction is$2500 or more,a RECORDED Notice of Commencement is required_
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERIENGINEER: 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:
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.
/ f S
_Sign ure of Owner/Lessee/Agent Sig at re of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie COUNTY OF strum.
The fowing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z day of A0 20 is by this X day of A,,a 20 (g by
Edward D.Jendon Edward D.Jendon
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic State of Florida) {Signature of Notary lic-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known '�/ OR Produced Identification
Type of Identification Pr Type of Identification Prgtiuc
f oi0r Notary Public State of Florida
s Notary Public State of Florida ` ' Ed don
Commission No. _° dwr$ )Jendon Commission No. My Co l GG 17851t
ry ■ My Commission GG 178514 ~ ,k Expires g5119l2g22
+yam d Expires 051 1212022
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS