HomeMy WebLinkAboutBuilding Permit Application Nov 0718.81:48p Jensen Beach Plumbing 7722256778 P.1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: A Permit Number: RECEIVED Building Permit Application NOV 0 7 2018 Planning and Development Services �T.Lucie County, Permi]tting Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone:(772)462-1553 Fax:(772)462-1578 Commercial ba Residential X PERMIT APPLICATION FOR: Plumbing-PROPOSED IMPROVEWNT LOCATION.Address: 19 Lake Vista Trail#106 Part St.Lucie 34962 Legal Description: Vista St Lucie Bldg 19 Unit 106 It- 3422-500-0258-000-3 Lot No.PropertVTaxlD Site Plan Name: Block No.Project Name:Setbacks Front Back: Right Side: Left Side:DESCRIPTION:OF WORK:Install 30 gat low boy skinny electric water heater under A/C unit Lc 6��,STRUCTION INFORMATIC11q.OElectric 21 Plumbin.g 0 Sprinklers Generator Roof Roof pitch Total Sq. Ft of Constructlon: SQ. Ft. of First Floor:Cost of Construction:$ 900-00 Utilities;[]Sewer[--]Septic Building Height:-6W—NER/LESSEE: CONTRACTOR:NameAnthany Carollo Name: Lonnie Culbertson....Address-23 Hedge Lane Company:Jensen Beach Plumbing,Inc City: Westbury State: NY Address: 1086 NE Industrial Blvd Zip Code: 11590 Fax:- City: Jensen Beach State:FL Phone No. Zip Code: 34957 Fax:772-225-6779 E-Mail: Phone No. 772-225-6600 Fill in fee simple Title Holder on next page(if different E-Mail: madah@jensenbeachplumbing.corn from the owner fisted above) State or County License: RF1067372 if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Nov 0718,01:48p Jensen Beach Plumbing 7722256779 p.2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFaRMATION:
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:loss NF indutriai BIvr Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do thework and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
5t.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 Assocration 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
cornmencing work or recording our otice of Commencement. ,
ignatureof Owr(er s 1contra or as Agent for Owner ignature of Contra icense Ho"Taer
STATE OF FLOP
A STATE OF FLORIDA
COUNTY OF_ #1 f.1 COUNTY OF MQe:H 1,,�
The foging instru ent was acknowledged before me The forgoing instru ent was acknowledged before me
It ��day of �.2010_ by this"i day of� 26M by
Name of person making statement Name of perso making statement
Personally Known _OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sign tore of Notary Public-Stat {Sign ore of Notary Fublie- iI US
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17