HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/13/19 Permit Number:
S J _ !-
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 TVPE:PLUMBING WHOLE HOUSE REPIPE
PROPOSED IMPROVEMENT LOCATION:WHOLE HOUSE
Address: 4008 GREENWOOD DR FORT PIERCE FL 34982
IAA Property Tax ID H: 2421-702-0006-000-6 Lot No.5
!R Site Plan Name: GREENWOOD BLK 1 LOT 5 (0.27 AC) (OR 3824-1717; 1718) Block No. 1
V M
'. Project Name: MILLER REPIPE
DETALLED DESCRIPTION OF WORK:
WHOLE HOUSE REPIPE
I
y CONSTRUCTION INFORMATION:
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: Sq. Ft. of First Floor:
Cost of Construction:$ 2700.00 Utilities: _Sewer _Septic Building Height:
G vVNER/LES' __ CONTRACTOR:
NameJASON L MILLER Name: ROBERT LUDLUM
Address:4008 GREENWOOD DR Company: BENJAMIN FRANKLIN PLUMBING
City: FORT PIERCE State: F1 Address: 1631 SW SOUTH MACEDO BLVD
Zip Code: 34982 Fax: City: PORT ST LUCIE State: FL
Phone No. Zip Code: 34984 Fax: 772-871-9069
E-Mail: PERMITS@BENFRANKLINPLUMBER.COM Phone No 772-871-9494
Fill in fee simple Title Holder on next page ( if different E-Mai[PERMITS@BENFRANKLINPLUMBER.COM
from the Owner listed above) State or County License CFC1426801
If value of construction is $2500 or more, a RECORDED Notire of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: = Not Applicable
Name:
MORTGAGE COMPANY: xNot Applicable
Name:
Address:
Address:
City: State:_
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x 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
"WARNWG TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYEME TO YOUR PROPERTY. A NOTICE OF COMMENCE ERT M BE RECORDED AND
POSTED ON JOB BEFORE THE FIRST INSPECTION. IF TO NTEND OBT N FINANCING, CONSULT
WITH Y ER ORNEY BEFORE RECORDING YOUR IY I OF CEMENT."
It
1
Sign r/ ssseep Contractor as Agent for Owner
Sign n s;7Holder
STATE OF FLORIQA'
STATE OF FLORID
COUNTY OFBUNrwm,
COUNTYOF.INTc E
The forgoing instrument was acknowledged before me
The forgoing Instrument was acknowledged before me
this a day of NOVEMBER 20 /f by
this day of N EMBER 2017 by
Name of person making statement.
Name of person making statement.
Personally Known ✓ OR Produced Identification _
Personally Known i/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Si ure of N/ ary/Pink' - tate of Florida)
(Signature o/f�1 ary Public-S a Florida)
Commission IJe! Non�>re� smmmFlmtle
Commis, No.
Lesli D Graham
, Commission GG 2aasa
ror
dW� Nolary Public SvW0f1kxk.
3' LesllDGrahem
REVIEWS
FRO
"Pin
PLANS
o
VEGETATION 1f°
mMon Se502
VE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.