HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01/16/2019 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 X
PERMIT APPLICATION FOR: Plumbing
Address: 423 E Coconut AVE
Legal Description: RIVER PARK -UNIT 2- BLK 1 LOT 24 (MAP 34/22N) (OR 718-17: 815-2798:
Property Tax ID #: 3419-510-0024-000-5
Site Plan Name:
Project Name: WATER HEATER
Setbacks Front Back:
Right Side:
40 -GALLON GAS WATER HEATER REPLACEMENT
]UILIUllal wurK to ue oerTormea under tms permit — CI
0 1 Gas Tank ❑Gas Piping
❑Electric ❑✓_Plumbing []Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 2.110.00
Left Side:
apply:
Shutters
Generator
S Ft. of First Floor: _
Utilities: 11 ❑Septic
Lot No. 24
Block No.
❑ Windows/Doors
❑ Roof ❑ Roof pitch
Building Height:
OW - SSEE:
Name: RICHARD BASSOFF
Name James E Trent & Carolyn Trent
Address: 423 Coconut Ave E
Company: ADMIRAL PLUMBING SERVICE, LLC.
City: PORT ST LUCIE State: FL
Zip Code: 34952 Fax:
Phone No.
Address: 2895 JUPITER PARK DR, STE 700
City: JUPITER State: FL
Zip Code: 33458 Fax:
Phone No. 561-746-1180
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: PERMITTING@THEADMIRALPLUMBER.COM
State or County License: CFC1426115
IT value of construction is $z500 or more, a RECORDED Notice of Commencement is required.
DESIGNI
Name.
Address
City-
Zip:
ityZip:
State:
Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: _
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Name:_
Add resS: 2895 JUPITER PARK DR, STE 700
STATE OF FLORIDA
Address:
City:
COUNTY OF PALM BEACH
City:_
Zip: Phone:
of
Zip:_
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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-vr recording vour Notice of Commencement. 1___) i
Rev. 8/2/17
Signature of Owner/ Lessee/Contract r as n or Owner
!
Signature of Contractor/License Hold
STATE OF FLORIDA
STATE OF FLORIDA /
COUNTY OF PALM BEACH
COUNTY OF PALM BEACH
The forgoing instrument was acknowledgpdkbefore me
this 18TH day JANUARY by
The forgoing instrument was acknowledfa before me
this 18TH day JANUARY 20_L by
of
of
RICHARD BASSOFF
RICHARD BASSOFF
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
JM(16�,_�i,C�
)' Llao, , p
(Signature pf Notary Public- State of Florida
(Signature of No Public- State of Florida I
"" 41 NICOLE M BUI,�,� �N
Commissio o
" "'
Commission No. NICOLE M �Sgg,Ijl,ryAN
- �`
-E6MMtSSION # GO 3725
-'+
:.? : COMMISSION # GG043125
EXPIRES October 30, 2020
.•Flt,. EXPIRES October
30, 20 20
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
M OVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17