HomeMy WebLinkAboutPermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO 13E ACCEPTED
Date: Permit Number:
ti J
Building Permit Application
Plamring 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 APPLICATION FOR: Plumbing — ---- --- l
PROPOSED IMPROVEMENT LOCATION:
Address: 6016 Indrio RD, Unit Apt J8 Fort Pierce, FL 34951
Legal Description: INDIAN PINES VILLAGE- BLDG J UNIT 8 AND PRO-RATA SHARE IN COMMON ELEMENTS
Property Tax ID N:
Site Plan Name:
Project Name: —
Setbacks front Back:
Right Side: __—Left Side:
Install customer supplied 30 gallon low boy water heater.
Block No,
CONSTRUCTIUfV INFORMATION::. _,
Additional worK to a performed unn er t u� s permit -- chec all- app y: —_— — — "--
tt❑_IlHVAC � Gas Tank Gas Piping utters j�,1I Windows/Doors
l_I Electric U1 Plumbing Sprinklers ` =I Generator El Roof Roof pitch
Total Sq. Ft of Construction: S Ft. r
of First Floor:
Cost of Construction: $ Utilities:nSewer L lSeptic uildin Bg Height:
OWNER
/LESSEE:
CONTRACTOR:
Name Cynthia K Clare
Name: Gary W. Evers
Address: 6016 Indrio RD, Unit Apt J8 Fort Pierce, FL 34951
Company: First Quality Plumbing
Address: 746 N. VOIUSIa Avenue
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City: Fort Pierce State: FL
Zip Code: 34951 Fax:
City: Orange City--
State: PL---
Phone No, 772-979-0977
Zip Code: 32763 Fax: 321-610-3919
E-Mail: palnnbayservice@fgplumbing.con
Phone No. 321-253-3939
Fill in fee simple Title Holder on next page ( if different
E-Mail: palmbayservice@f(lplurnbing.com
from the Owner listed above)
State or County License:
rr varue or cmisvuaron is >nw or more, a necurtutu ntotice of cormnencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY. Not Applicable
Name:
Name:
Address:_ — ---
-- -- — ----—
-- --
Address:
City: State:
City:
Zip: _--_-- Phone -
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Zip:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City:
Zip: _ Phone:
Zip:
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. ucie 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.
It
Signature of Contractor/License Holder
Signatidre of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
SPATE OF FLORIDA
COUNTY OF i
COLINTY OF
The for mg instrument was acknowledged before me
The forgpj,7g instrument vas acknowledged before me
�dayot
this day of ?C.,•}' N.i— ,.20� by
this C.-) r, (>,(I�:,R'. ,20t` by
Name of person making statement
'i4ame of person making statement
Personally Known OR Produced Identification
Personally Known iLv � OR Produced Identification
_
Type of Identification
_
Type of Identification
Producedl)•L-. —' FL,.�-�(!.((CI �C ,dip-^(-(q®3g{^O
Produced_
igna[ur of Notar Pu ' -4tat �� i a
uy
(Signature of y Public- Stite of Florida
u0 teh Of Flatde
de J��to
Commission No. • rwnmlWFA G P08 y
Vi •-,,
Commission VNN ' ,GAYLE C @� �Y
— Eaplrel0t✓3W2020
F MY COMMISSION k F OS712
' q( EXPIRES April 06, 2020
—__
— _ {10r Sitf-0i61— -9pMrNOe _—
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
—
RECEIVED
DATE
COMPLETED
Rev, 8/2/17 - — - --- -