HomeMy WebLinkAbout20190228_00001All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/28/n Permit Number:
MOOS 19
trr9i
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 TYPE: plumbing permit
PROPOSED IMPROVEMENT LOCATION:
Address: 113 Queen Bess Court
Property Tax ID #: 1414-702-0022-000-9 Lot No. D
Site Plan Name: Block No. 23
Project Name:
DETAILED DESCRIPTION OF WORK:
Plumbinq: Relocatinq the existinq washing machine drain line and waterline aonrox 2ft.
CONSTRUCTION INFORMATION:
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:
Cost of Construction: $ _1.200.00
Sq. Ft. of First Floor: _
Utilities: —Sewer X Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name (' . CL Z' �.. • 0. ]'t--
Name:
Address:_ �� 1 r `' ' I -
Company:
^1-' ►t'�
City:w'f' .,7jr' i(,[ _ State:
Address:Suo
1L u
Zip Code: ��(� Fax: Iii rC
City: l��� "_11 l;(
tate:,.,
Phone No. � tk
? •3
Zip Code Ci
Phone No
Fax: T.jI t
E-Mail:j
Fill in fee simple Title Holder on next page (if different
E -Mail ;~Fl CE° E ii1
'"' J �
State or County License
,
o( 5�--
from the Owner listed above)
If value of construction is 52500 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 thepermit 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Y0JJR LENDER 6111 AN ATTORNEY BEFORE RECORDING YOUR NOTICE nF CnMMFNCFMFNT „
Rev. 2/7/19
tX
Signature of Owner/ Lessee/Contractor as Agent
for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
r._ rn z,
COUNTY OF - 7�j -VC I��
M
COUNTY OF �i L�' Gi _
00
—C o
The forgoing instru ent was acknowledged befc on C
day
The forgoing instrujent was acknowledged before nQ a
' E
this of 20 bye
�
this day of t �� 20 by
tlp�cm On
O(L'fylc'�S
MCI
e
Name of person making statement.
z E L
Name of person making statement.
Personally Known _1 OR Produced Identificatfah
O p
O°
U Cn
Personally
Known OR Produced Identificatiorly""""a,
Type of Identification
��
�,
Type of Identification
;a��`
Produced
`'����•A•'
��,��Fi,
Produced
(Sig4tuYe of Notary Publ - State of Florida)
(Signature of Notary Public SYtate of Florida )
Commission No.����'r (Seal)
Commission No. �� I� (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
�'`
M
tl
x
o$
s
,�
u�
Y
4
W
L
3
z