HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: 19 • /s LY• Permit Numb
RECEIVED
Building Permit Applicatio OCT 1 5 2018
Planning and Development Services Permitting itti n g
Building and Code Regulation Division Department
2300 Virginia Avenue,Fort Pierce FL 34982 S • u i exCo u n t FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Yr
PERMIT APPLICATION FOR: PlumbingLvi
PROPOSED IMPROVEMENT LOCATION: .
Address: 6113 Bamboo Drive
Legal Description: Lot 22&23 Blk 94 Unit 9
Property Tax ID#: -899428478880 Lot No.23&24
Site Plan Name: Block No. 94
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF WORK:
Easy Street Project-Water hookup
CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit–check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers 1-1 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
�p
Cost of Construction:$ � Lo C9 C2' Utilities:0 Sewer F]Septic Building Height:
.OWNER/LESSEE: CONTRACTOR:
Name Jerrie Moore Name: City of PSL Utility Systesm
Address:6113 Bamboo Drive Company:
City: Port St Lucie State:Fl Address: 900 SE Ogden Lane
Zip Code: 34982 Fax: City: Port St Lucie State:FI
Phone No. Zip Code: 34983 Fax: 772-873-6405
E-Mail: Phone No. 772-873-6400
Fill in fee simple Title Holder on next page(if different E-Mail: moon@cityofpsl.com
from the Owner listed above) State or County License: 25597
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON5TRUCTiON'LIEN LAW;INFORMATION: ;
DESIGNER/ENGINEER: _No,t 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 Counter 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,1 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 recordine vour Notice of Commencement.
Signature of Owner)Lessee/Contracto as Agent for Owner Sign ure of Contractor/License Ider
STATE OF FLORID ?''µN STA OF FLORIDA
COUNTY OF 4 COUNTY OF na
''•Aoinfiia•
The forgoinginstrument was a knowledge of re o The forgoing instrument was acknowledged before me
of Lf Zj 20 Mf b d X
this/5 da/ p this 3 day of October 20_ by
:go c
,y� ODE i
Name of person_making statement b o= Name of person ma g statement
Personally Known OR 'Produced Identificati �a� Personally Known x OR Produced identification
Type of identification oy$ Type of Identification
Produced mN Produced
ignature of Vary Public-State of Flo ' a) (Sign re of Notary Public-Statelof Florida)
Commission No. (Seal) Commission No. U''.,,.
HYo JEANETT DG037064
'o=Notary Public-Sta
• Commission#GMy COMM-Upirm,24' 6ontled throughNationREVIEWS FRONT ZONING SUPERVISOR PLANS VEG E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW-
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17