HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-A P 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 TYPE: PLUMBING
PROPOSED IMPROVEMENT LOCATION:
Address: 9417 S OCEAN DR
Property Tax ID #: 3535-333-0001-420-2
Site Plan Name:
Project Name: WATER HEATER
I DETAILED DESCRIPTION OF WORK:
40- GALLON ELECTRIC WATER HEATER REPLACEMENT
Lot No.
Block No.
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: $ 2,265.00 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Samuel M Pugliese
Name: RICHARD BASSOFF
Address: 1019 Old Pleasant View Or
Company: ADMIRAL PLUMBING SERVICES, LLC
City: Apollo PA State: _
Zip Code: 15613 Fax:
Phone No. 724-640-1171
Address: 2895 JUPITER PARK DR STE 700
City: JUPITER State. FL
Zip Code: 33458 Fax:
Phone No 561-746-1180
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail 208PERMITTING@SERVICEEXPERTS.COM
State or County License CFC -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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
COUNTY OF PALM BEACH
Address:
The f99r�going instrument was acknowledged before me
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City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of Identification
Address:
Produced
City:
oW Notary Public State of Florin
City:
f Jacqueline Georgescu
/ y . My Commission GG 23318
Zip: Phone:
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Zip: Phone:
( ' nature of Not y Public- Stmissio
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR,LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTJCE OF COMMENCEMENT."
Rev. 2///19
Signature of ner/ Lessee/ ontroto as Agent for Owner
Signature of Contractor/Licens oldK
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF PALM BEACH
COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me
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The f99r�going instrument was acknowledged before me
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this day of DZ (� 20_ by
this day of DQ(? 20� by
RICHARD BASSOFF
RICHARD BASSOFF
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
Type of Identification
ProducedryPubllcStateofFloride
Produced
Jacqueline Geor6escu
oW Notary Public State of Florin
g� 1� My Commission GG 233150
'?p moo/ Expires 08/28/2022
f Jacqueline Georgescu
/ y . My Commission GG 23318
/
'od�, Expires 08/28/2022
nature tary Public- State of Florida )
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Io. (Seal)
mmission N (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2///19