HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/03/2018 Permit Number:
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 d
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 253 NE Prima Vista Blvd - Port SL Lucie, FL 34983
Legal Description: RIVER PARK -UNIT 5 BLK 43 LOT 3 (MAP 34/28N) (OR 3571-728).
Property Tax ID N: 3419-540-0003-000-5
Site Plan Name:
Project Name: New Wash/Laundry Drain Location
Setbacks Front Back:
Right Side: Left Side:
Lot No. 3
Block No. 43
I DETAILED DESCRIPTION OF WORK: 11
Relocate wash machine waste to kitchen stack and run new hot/cold supply lines for laundry off
existing water heater supply lines in garage.
Sas Piping (Shutters
Sprinklers Generator
SFt. of First Floor: _
Utilities Sewer 11Septic
❑ Windows/Doors
Roof = Roofpitch
Building Height:
OWNER/LESSEE:
UGas
Tank
j�HVAC
L (Electric
❑✓_Plumbing
Company: Benjamin Franklin Plumbing
City: Port St. Lucie State: _
Zip Code: 34983 Fax: Fila
Phone No. 772-871-9494
Total Sq. Ft of Construction:
City: Port St. Lucie State: FL
Zip Code: 34984 Fax: 772-871-9069
Phone No. 772-871-9494
Cost of Construction:
$ 3000.00
Sas Piping (Shutters
Sprinklers Generator
SFt. of First Floor: _
Utilities Sewer 11Septic
❑ Windows/Doors
Roof = Roofpitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name TIF -FK -B LLC cJo S Floritla Field Services
Name: Robert W. Ludium
Address: 253 NE Prima Vista Blvd
Company: Benjamin Franklin Plumbing
City: Port St. Lucie State: _
Zip Code: 34983 Fax: Fila
Phone No. 772-871-9494
Address: 1631 SW South Macedo Blvd
City: Port St. Lucie State: FL
Zip Code: 34984 Fax: 772-871-9069
Phone No. 772-871-9494
E -Mail: File
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: Permds@benfranklinplumber.com
State or County License: CFC1426801
IT valYe ar COTSIT.eOn n>UW or more, a KtLURDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:_
City:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER:
Name:
_Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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
Signature of UwnelnesSee/ContrattOr as Agent for Owner Slgeatnre m LontoNcIl cense halter
STATE OF
STATE OF
COUNTY OF FLORIDA Sill, Ot Lp A:. COUNTY OF OR S Xvt>,Rxi
The for Ing instrument was acknowledged before me The forging instrument was acknowledged before me
this,dayof_ZN,e, kl .20\-'�by this dayofbncm`Q, .201 by
Rjlr.v \_llaky W. RobeTV Lk,dk LA M
Name of ersonl�✓akin statement Name of persp making statement
Prrcnnally Known OR Produced Identification -Personally Known r/ OR Produced Identification
Type of
RHONDA
EXPIRES January 08. 2021
(Signature of Nota}y laublil State of Florida I
Commission No. C&i (Seal)
REVIEWS
Rev.
of
(Signature of Not"PubliN State
Commission No. C160S'3laa
MY COMMISSION N GG
EXPIRES January D8,
(Seal)
COUONTER REVIEW SREVIEWOR I REVIEW PLANS I VEGETATIE EW ON S EV EWLE MRE EW ANGROVE