HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' �l Permit Number: 0 J�
f4 s=
RLCEIVED
Building Permit Appli tion JAN 2 2 2019
Planning and Development Services Permitting
Building and Code Regulation Division g Department
2300 Virginia Avenue,Fort Pierce FL 34982 R. LU l e County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMITTYPE:PIumbing
Address: 9412 Poinciana Ct Ft. Pierce, FL 34951
Property Tax ID#: 1334-503-0017-000-5 Lot No.
Site Plan Name: Block No.
Project Name:
NO�;'%/%/moi%/�%//��/
Install new shower Pan in existing area
j/'// Mm9mai /r/ r 011/11/1
�y
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: $ ()' 0.6Utilities: —Sewer —Septic Building Height:
Name Erwin Schultz Name:Michael Coleman
Address:9412 Poinciana Ct. Company:Prefab Plumbing Inc
City: Ft. Pierce State: 4- Address:1100 Carr St
Zip Code: 34951 Fax: City: Palakta State:FL
Phone No.772-464-0190 Zip Code: 32177 Fax:
E-Mail: Phone No386-546-7643
Fill in fee simple Title Holder on next page(if different E-Mail mgc1980@gmail.com
from the Owner listed above) State or County License CFC043003
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 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 or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor a ent for Owner Signature of Contractor/License Holder
STATE OF FLO A STATE OF FLORIDAA/�
COUNTY OF��(`)Z"MA-P COUNTY OF 'b 40- SAM
The for oing instrument as acknowledge"efore me The for oing instrument was acknowledge efore me
this day of Q 20 fah by this day of r 20 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identi ' on Type of Identificat'
Produced Produced
(Signature o I (Signature e o F orida
otary Public State of Florida ° Nota
Commissio KATHRYN POCKS( _ �c Notary Public State ofo�+
oasa��ss�on GG 0 ���j Commission o. ^ I 'POCK 1,
cT� Expires 11/21/2020 ' � dp• My Commission GG 049422
or ns Expires 11/21/2020
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE V14INGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.9/26/18