HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/29/19
COUNTY
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: PLUM BI NG
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential X
Address: 3212 S Lakeview CIR # 10205 Fort Pierce, FL 34949
Property Tax ID #: 1425-605-0071-000-3
Site Plan Name:
Project Name: WATER HEATER
DETAILED DESCRIPTION OF WORK:
30- GALLON ELECTRIC LOWBOY WATER HEATER REPLACEMENT
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Lot No.
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 1.400.00
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Mary S Vlasuk
Name: RICHARD BASSOFF
Address:3212 S LAKEVIEW CIR 10205
Company: ADMIRAL PLUMBING SERVICES, LLC
City: Fort Pierce State: _
Zip Code: 34949 Fax:
Phone No. 772-475-3733
Address: 2895 JUPITER PARK DR STE 700
City: JUPITER State: FL
Zip Code: 33458 Fax:
Phone No 561-746-1180
E-Mail: susanv2009@gmaii.com
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:
Name:
City:
Zip:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 Court makes no representation that is granting a permit will authorize thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 NOTICE OF COMMENCEMENT."
Signat r caner/ Lessee Co ract s A nt for Owner
Signature of Contractor/License Hgl le
STATE OF FLORIDA
STATE OF FLORIDA `
COUNTY OF PALM BEACH
COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 2B day of NOVEMBER .20 by
this 28 day of NOVEMBER 20_ by
RICHARD BASSOFF
RICHARD BASSOFF
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identificatio
Type of Identification
ProduC Ote*Rublic State of FIOnda
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Rev. 2///19