HomeMy WebLinkAboutBuilding Permit Applicaiton i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r�C)-0 cz-) -NT'1122'T110-70-
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RECEIVED ,i
Building Permit Application
JUN 0 5 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St., Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE:Plumbing
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Address: 3200 Twin Lakes Ter Ft Pierce, FL
Property Tax ID#: 1327-704-0084-000-0 Lot No.
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Site Plan Name: Block No.
Project Name:
Krom
Remove existing tub Install new Walk in Tub. No tile or dry wall work being done
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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 P tch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1700.00 Utilities: —Sewer —Septic Building Height:
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NameSylvia Krom Name:Michael Coleman
Address:3200 Twin Lakes Ter#206 Company:Prefab Plumbing Inc
City: Fort Pierce State:_ Address:1100 Carr St
Zip Code: 34951 Fax: City: Palakta State:FL
Phone No.772-465-0476 Zip Code: 32177 Fax:
E-Mail: Phone No 386-546-7643
Fill in fee simple Title Holder on next page(if different E-Mail mgcl980@gmail.com
from the Owner listed above) State or County LicenseCFC043003
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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.
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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 structluire
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
WIT 11 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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81g'natlurf of Owner/Le' /Contractor as Agent for Owner Signature of Contractor/License Holder
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STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF -23W_ W
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The f ing instru t was a wle gprLpefore me The forgoing instrument was acknowlecig before me
this 15" ,20ZY by this,3 dayof-_-TT3"iL'_ r by
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Nam g(of'person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known '®R Produced Identification
Type of IdentIfl 0 Type of Iden
Produce.d
d Produced
t9rY Public state of Florida
Y Commission GG 040411
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(Signature
C., My Commission GG 049422
Commissi n o.- (Sea[) Commission o, Expires 11/21/2020 (Seal)
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Rev2/7/19