HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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
PERMITTYPE: PLUMBING
Address: 413 WILLOW AVE
Property Tax ID #: 3419-510-0183-000-7 Lot No. 18
Site Plan Name: Block No. 16
Project Name: SHOWER PAN REPLACEMENT
TAILED DESCRIPTION OF WORK'
SHOWER PAN REPLACEMENT EXISTING SHOWER, NO MODIFICATIONS
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 1,550.00 Utilities: _Sewer _Septic Building Height:
Name MARGARET WALL Name: RICHARD BASSOFF
Address: 413 WILLOW AVE Company:ADMIRAL PLUMBING SERVICES
City: PORT SAINT LUCIE State: _ Address: 2895 JUPITER PARK DR
Zip Code: 34952 Fax: City: JUPITER State: FL
Phone No. 772-370-0169 Zip Code: 34952 Fax:
E -Mail: Phone No 561-746-1180
Fill in fee simple Title Holder on next page ( if different E -Mail PERMITTING@THEADMIRALPLUMBER.COM
from the Owner listed above) State or County License CFC -1426115
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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:
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 such
prohibit
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
commencin rk or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Si ture of Contractor/ ' ense Hoi r
/
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF PALM BEACH
COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this? day Of JANUARY 20_ by
this » day of JANUARY 2 by
Name of person making statement.
Name of person making statement.
Personally Known —bR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
I '
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