HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
•
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: 5501 BUCHANAN DR
Legal Description: INDIAN RIVER ESTATES -UNIT 1- BLK6 LOTS 9 AND 10 (MAP 34111 N) (OR 1507-2032)
Property Tax ID #.. 3402-602-0201-000-0
Site Plan Name:
Project Name: MOSHER
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK:
40 GAL ELEC WATER HEATER REPLACEMENT
Lot No._
Block No.
CONSTRUCTION INFORMATION:
Additional work to orme under this permit — c ec a apply:
C]HVAC f]Gas Tank Gas Piping Shutters ❑ Windows/Doors
11 Electric 0 PlumbingSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:.
Cost of Construction: $ 1210
5 Ft. of First Floor: _
Utilities:0Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Maynard M Mosher
Name: DIMITRE BOBEV
Address: 5501 BUCHANAN DR
Company: FLORIDA DELTA MECHANICAL
Address: 8402 LAUREL FAIR CIR SUITE 111
City: FT PIERCE State: FL
Zip Code. 34982 Fax:
City: TAMPA State: FL
Phone No. 772-332-7120
Zip Code: 33610 Fax: 866-219-0729
E-Mail:
Phone No. 866-219-0880
E-Mail: FLPERMITS@DELTAMECHANICAL.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above]
State or County License: CFC1425917
11 value vt wnsirueuon is ;�cwu or more, a KtLUKutU Nonce or LOMmencement is required.
SUPPLEMENTAL 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 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.
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 bylaws
rules, 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 Not" of Commenceme t must be recorded and posted on the jobsite
before first in ecti . if y int d to obtain financi nsult ith lender or an attorney before
comm nci wor or re rdi o Notice of Commenc m t.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF r .��� _
STATE OF FLORIDA
COUNTY OFr'`l S
The for ing instrument was acknowledged before me
The for Ding instrument was acknowledged before me
{,j/s
this day of GV 20��by
this day of ,20_(�Fby
Name of person making statement
Name of person making statement
Personally Known c.-K_ OR Produced Identification
Personally Known _o( OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Signature of
- Std
{Signature
:; 9G L I
MY COMMISSION
-;� E=MILY H. MEDINA
Commission
..;
•o: ES:Ju t
Commissio HQ. : = MYCOMMlSSloN#GG�
',F� d4?c Bonded Thru Notary Public underwriters
,F aQ EXPIRES: June 11, 2022
Bonded ThM Notary Pubrrc underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17