HomeMy WebLinkAboutBuilding permit applicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YO ! LEND R-AN ATTORNEY JBIEFORE RECORDING YOUR Ngp4if OF COMMENCEMENT."
Signature wner/ Lessee/ ontr ctCI gent for Owner
Signature of Contractor/License Hot r
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STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFPALM BEACH
COUNTY OFPALM BEACH
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 19 day of JUNE 20" by
this 19 day Of JUNE 20LC1 by
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 Id ntification
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/19119
COUNTY
F 1. 0 a 1 C
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential X
PERMIT TYPE:BACKFLOW REPLACEMENT
PROPOSED IMPROVEMENT LOCATION:
Address: 2507 N Ocean DRHutchinson Island, FL 34949
Property Tax ID #: 1425-603-0010-000-2
Site Plan Name: SUSAN CARMELI
Project Name: BACKFLOW REPLACEMENT
DETAILED DESCRIPTION OF WORK:
SUPPLIED AND INSTALLED 1" WATTS- 919QT BACKFLOW
CONSTRUCTION INFORMATION:
Lot No.
Block No.
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: $
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameSUSAN CARMELI
Name:RICHARD BASSOFF
Address:2507 N OCEAN DR
Company:ADMIRAL PLUMBING SERVICES, LLC
City: HUTCHINSON ISLAND State: _
Zip Code: 34949 Fax:
Phone No.516-641-7795
Address:2895 JUPITER PARK DR
City:JUPITER State: FL
Zip Code: 33458 Fax:
Phone N0561-746-1180
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 LicenseCFC-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.