HomeMy WebLinkAboutPLUMBING - RESIDENTIAL All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `aX� �� Permit Number' �_y7�`'�
_ ACEI V ED
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• Lucie County, Permitting
Building Permit Applicat'e�m
Planning and Development Services
euilding'and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (77.2)462-1553- Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FC1R•- - - -
PROPOSED iNP'' OUEME T LOCAT c� •
Address: 0. d
Legal Description: nt!� -7449� f pr S '-t 5�� t'V 11
cc_ SSW
PropertyTax ID#: 0`�4. a� �C 02 � � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front. -Back: Right Side: Left Side:
DETA rI,IDE�5CR PT10 rgOF WOR
T21l�I,rY1 `I �'
C
CO THEM'
'MFORM IQ
itional work to be pertormed under this permit-check all that appy:
_Mechanical ' GG s Tank —Gas Piping —Shutters _Windows/Doors
Electric a Plumbing —Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer Septic . Building Height:
OWINER/LMN �: C®NTRA
Name ��c h ('` Zvi Name:
Address: a�o� `��\ � Company:
City: NrA--: 31Q p-c e- State: Address:
Zip Code: 34 "1 Fax: City: State:
Phone No. - SLpi • 1 Zip Code:. Fax:
E-Mail: T- Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,-a RECORDED Notice of Commencement is required.
Sl3PPLEMEN Al.CUNSTRt1C7ION LIQ NOLAIN I'NFORMA 1Q .
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 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.
Sign re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR� A STATE OF FLORIDA
COUNTY OF , L oC COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisZ4 day of c 201N by this day of 20_ by
isc�s uQ,t
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi ation Type of Identification
Produced Produced
(Signature of NotI OVENS (Signature of Notary Public-State of Florida)
D
MY COMPJIISSIDN#GG 022023 I
Commission No. plREs:DKmor16,2020 (Seal) _
�
Commission No.
%�FOFF�o?•' Bonded7tiNNotary Public Undenurte
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 812117