HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Ct " i I q Permit Number:
s - 4
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: 7405 Brookline Ave
Legal Description:
Property Tax ID #: 1301-607-0241-000-1
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: II
Change out existing gas hot water heater �/,)
CONSTRUCTION INFORMATION:
Additional wor tv e neorme under this permit - c ec a apply:
0-HVAC 1:1 Gas Tank []Gas Piping _ Shutters a Windows/Doors
11 Electric WIPlumbing Sprinklers Generator Ll Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 1250.00
S Ft. of First Floor: _
Utilities:0 Sewer [I Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Kenneth Whisner
Name: Reed Sudderth
Address: 7405 Brookline Ave
Company: CRS Plumbing
City: Fort Pierce State: Fl_
Zip Code: Fax:
Phone No. 772-224-9297
Address: P.O. Box 12755
City: Fort Pierce State: FL
Zip Code: 34979 Fax: 772-460-7774
Phone No. 772A66-7763
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail• crsplumbing@belisouth_net
State or County License: CFC1426853
If value of construction is $2500 or more, a RECORDED Notice of commencement is requireo.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit.
_Not Applicable
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
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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencill work or recordine your Notice of Commencement.
s
_ Signalfure of Owner/ Lessee/Agent Signat6o of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF sc L-cir-
The forgoing instrument was acknowledged before me
this 5 day of PW, 20 (9 by
STATE OF FLORIDA
COUNTY OF -rud.
The forgoing instrument was acknowledged before me
this S day of KOY 20 -. by
Edward D. Jendon I Edward D. Jendon
(Name of person acknowledging } (Name of person acknowledging)
(Signature of Notary Pub I - State of Florida } (Signature of Notary Pu li - State of Florida }
Personally Known rr OR Produced Identification
Type of Identification P
7.NOV Notary Public State of FR rida
Commission No. Edwatp illrdon
My Co missi n GG 178514
Expires 05/19/2022
Revised 07/15/2014
Personally Known ✓ P d 1 11 1 _h a i
Type of Identification Pr ud
Edward D Jendon
Commission No_ Mycorn GG 170514
vo
orw Expirea OW19122
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