HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
dIIIIIII
nN
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 APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 5833 MOSS CT 3E
Legal Description: THE GROVE CONDOMINIUM -SECTION ONE- UNIT 3E (OR 4129-2181)
Property Tax ID ##: 3410-507-0011-000-4
Site Plan Name:
Project Name: Pruzinsky
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
30 GAL ELEC WATER HEATER REPLACEMENT
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional -work toe nertormed under this permit a che,all napply:
HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric 91 1 Plumbing ❑ Sprinklers 1:1 Generator Li Roof Roof pitch
Total Sq. Ft of Construction: .
Cost of Construction: $ 1389
5Ft. of First Floor: _
Utilities:'nSewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Jane Pruzinsky
Name: DIMITRE BOBEV
Address: 5833 MOSS CT 3E
Company: FLORIDA DELTA MECHANICAL
Address: 8402 LAUREL FAIR CIR 111
City: FT PIERCE State: FL
Zip Code: 34982 Fax:
City: TAMPA State: FL
Phone No. 973-420-6112
zip Code: 33610 Fax: 866-219-0729
-Mail:
Phone No. 866-219-0880
Fill in fee simple Title Holder on next page (if different
E -Mail: FLPERMITS@DELTAMECHANICAL.COM
State or County License: CFC1425917
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGVNEER: _ Not Applicable
Name:
MORTGAGE COMPANY: T 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 jobsite
beforee irst ins ectiorr� If you'inten o obtain financing, con with le der organ attorney b ore
comm ci R work r rec{p,,{-din"our otice of Commencement�f j ( J
1"'! � q,(-
Signature
,(
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF FIs
Theforgoing instrument was acknowledged before me
this 2 }'day of 0( , 20_0 by
Name of person making statement
Personally Known 0( OR Produced Identification
Type of Identification
rVJ'0_
(Signature of N
am
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF _�—L/ Is
The forgoing instrument was acknowledged before me
tnis 2-5 day of oCt 20_rl by
Name of person making statement
Personally Known L--;�� OR Produced Identification
Type of Identification
Produced
(Signature of
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
.=r ...
• '�"..
EMILY H. MEDINA
Commission No.
,s
MYCOMMISS ItpG22T456
Commission N
"• MISSIONk%A7056
P83E5: Jane 11.2022.•
. :a,'
EXPIRES: June 11, 2022
Boded Thru Notary Public underwriters
' ff of �t�.:`
Bonded Thru Notary Public UndervMters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
I
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17