HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: October 1, 2018 Permit Number:
.J
•
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: 19 Lake Vista Trail 105 Port St. Lucie, FL 34952
Legal Description: Vista St Lucie Building 19 Unit 105
Property Tax ID #: 3422-500-0257-000/6
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Install washer box with drain
Right Side
Left Side:
Lot No.
Block No.
CONSTRUCTION INFORMATION: - }
Additional work to e Pertormed un er t is permitt-c e-cl -ai _pp
y:
LdHVAC Gas Tank DGas Pipingh
0 Windows/Doors u
Electric❑ Plumbing [] Sprinklers LJ Generator L=1 Roof Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 650.00
Sq. Ft. of First Floor: _
Utilities: L_ISewer [Septic
Building height:
OWNERAESSEE:
CONTRACTOR:
Name Norma Pi=imenti
Name: Gary W_ Zanello
Address: 19 Lake Vista Trail 101
Company: Port St Lucie Plumbing
City: Port St Lucie State:FL
Zip Code: 34952 Fax:
Phone No. 772 340-7417
Address: 6907 Heritage Or
City: Port St Lucie State: FL
Zip Code: 34952 Fax: 772 489-9126
Phone No. 772 468-6524
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail. portstiucieplurnbing@gmail,com
State or County License: 'CFC058025
it value or consrrucuon is ;)[buu or more, a MMUKULD Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SiMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 your Notice of Commencement.
Rev. 8/2/17
Signatur f Contr or/License Holder
Signature f Own /Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFA--
COUNTY OFA--
The forgoing instrurpent was acknowledged before me
00t
The frging instrum nt asacknowledged before me
day L'
this day of— 20is by
this of _ t 20V by
Gary W_ Zaneila
Gary W. Zane!!o
Name of person making statement
Name of person making statement
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Danielle Higlin
- � . - Danielle Bigun
S -Au fFF9QS
(Signature of Notary Public- a tx o riel ) IXPIAES: August 25.2
EXPIRES -
911 na
1 g tore of Notary Public- f Edda) EXPIRES: August 25, 21N
Commission No. FFsoYanse %Fp+�`,ea{) Y�fNVP.AAiiftNlVi)TAftY.0
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commission No_ao�ansg (Seal)
I
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17