HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
4 J _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 89 Queens RD
Legal Description: QUEENS COVE -UNIT THREE- BLK 25 LOT 18 (OR 3285-567)
Property Tax ID #: 1423-602-0018-000-9
Site Plan Name:
Project Name: Richard M Van Lith
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
40GAL ELEC WATER HEATER REPLACEMENT
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to e performed under this permit — check all apply:
0HVAC E Gas Tank ❑Gas Piping _ Shutters !.___1 Windows/Doors
1-1 Electric 0 Plumbing Sprinklers Generator Q Hoof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1222
5 Ft. of First Floor:
Utilities: Sewer El Septic Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name Richard M Van Lith
Name: DIMITRE BOBEV
Address: 89 Queens RD
City: FT PIERCE State: FL
Zip Code: 34949 Fax:
Phone No. 561-289-7510
Company: FLORIDA DELTA MECHANICAL
Address: 8402 LAUREL FAIR CIR 111
City: TAMPA State: FL
Zip Code: 33610 Fax: 866-219-0729
Phone No. 866-219-0880
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: FLPERMITS@DELTAMECHANICAL.COM
State or County License: CFC1425917
IT value of construction 1s,5Z500 or more, a RECORDED Notice of Commencement 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.
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
is in Home Owners Association bylaws that may restrict or such
which conflict with any applicable rules, or and covenants prohibit
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
commen,Mg work pr recording our Notice of Commenceme
r
Signatur@ of Owner/ essee/ ontractor as Agent for Owner
Signature of Contractor/License Wolder
STATE OF FLORIDA
STATE OF FLORIDA I
COUNTY OF _ I -S
COUNTY OF
The f oing instrument was acknowledged before me
The far Ding instrument was acknowledged before me
DC
this day of �20 �clby
this day of C. 2011 by
oir Tic., & beo
D m D-C & b-eA ) -
Name of per on making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known Q( OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
(Signature of N f Florida)
(Signature of
r*o' .•
., �¢. EMILY H q
Commission No _ MMISSftlN�
Commission N
:A... EMILY H. MEDINA
r': MISSION �ft7056
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EXPIRES: June 11, 2022
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a EXPIRES: June 11, 2022
oc s ;�°' BondBd rhN Nota�•:;c.
ry Public Un
F�°°•' Bonded Thry Notary Public 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