HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
JJI-zl -ion
s _
mommosaw 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-iS78 Commercial Residential XXXX
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 3401 Bent Pine Dr
Legal Description: MONTE CARLO COUNTRY CLUB -UNIT ONE- LOT 27 (OR 2264-1981)
Property Tax ID #: 1327-801-0031--000-2
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Replace existing 50 gai hot water heater
CONSTRUCTION INFORMATION:
A itiona wor to 2 p8 orme un er
Right Side: Left Side:
LJ HVAC LJ Gas Tank uGas Piping
Electric F%/1 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 620.00
OWNER/LESSEE:
Name Donna -Jean Gabraith
Address: 3401 Bent Pine Dr
City: Fort Pierce
Zip Code: 34951 Fax:
Phone No.
I:-nnmih
Lot No.
Block No_
tnapply:
Shutters Q Windows/Doors
Generator 0 Roof
5 Ft. of First Floor:
Utilities:�SewerE]Septic Building Height:
State: FL
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
CONTRACTOR:
Name: Peed Sudderth
Company: CRS Plumbing
Address: P.0- Box 12755
City: Fort Pierce State: FL
Zip Code:
34979 Fax: 772-460-7774
Phone No. 772-466-7763
crsplumbing@belIsouth -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:
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:
1 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, wails, 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.
_ Signatur6"of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF stL-
The forgoing instrument was acknowledged before me
this `j day of 6(!�V 20 �13 — ley
Edward D. Jendon
(Name of person acknowledging)
(Signature of Notary Publi ate of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission NO. Notaq++� is5tateofFWida
_ Edv�Br Jendon
My Commission GG 178514
Expires 05!1912022
Revised 07/15/2014
s
Signatu.4 of Contractor/License Halder
STATE OF FLORIDA
COUNTY OF S,L.ae
The for Ding instrument was acknowledged before me
this day of 20 /$ by
Edward D. Jendon
(Name of person acknowledging)
(Sig ature of Notary Public ate of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produ
a,++" Notary Public State of Florida
r EdW Ed§FJ Jendon
Commission No- . MAYto�`mm' ion GG 178514
'�iq ryo Expires 05!19!2022
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DATE
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