HomeMy WebLinkAboutBuilding ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1113120 Permit Number:
an
Cour
F I n i
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: PLUMBING
PROPOSED IMPROVEMENT LOCATION:
Address: 3429 Red Tailed Hawk DR
Property Tax ID #: 3424-800-0115-000-6
Site Plan Name:
Project Name: WATER HEATER
Building Permit Application
Commercial Residential x
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
30- GALLON ELECTRIC WATER HEATER REPLACEMENT
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 1,675.00
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name David A Brown
Name: RICHARD BASSOFF
Address: 3429 Red Tailed Hawk DR
Company: ADMIRAL PLUMBING SERVICES, LLC
City: PORT SAINT LUCIE FL State: _
Zip Code: 34952 Fax:
Phone No. 772-249-0518
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 PERTMITTING@THEADMIRALPLUMBER.COM
State or County License CFC -1426115
it value or construction is >[buu or more, a ntcoitutD 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 f r ding instryyment was acknowled d before me
F
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Personally K own OR Produced Identification
Address:
Type of Iden fication
City:
P ced 00 Notary Public State of Florida
City:
acqueline Georgescu
Zip: Phone:
My Commission GG 233150
V dF Expires 06/28/2022
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 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 NOTICE OF COMMENCEMENT." i
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Sign atur er/Lessee/Contr ctor A ntfor Owner
Signatur ntractor/License older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF PALM BEACH
COUNTY OF PALM BEACH
The forgoing instryyment was acknowledged before me
day UA.n
The f r ding instryyment was acknowled d before me
F
this a_ of 202Z by
this day of <Jq,V\ 20,/G by
RICHARD BASSOFF
RICHARD BASSOFF
Name of person making statement.
Name of person making statement.
Personally Knowtx_ OR Produced Identification
Personally K own OR Produced Identification
Type of Identification
Type of Iden fication
P du
P ced 00 Notary Public State of Florida
Public State of Florida
acqueline Georgescu
.dyeNotary
Jacqueline Georgescu
GG 233150
My Commission GG 233150
V dF Expires 06/28/2022
My Commission
0 2 2
Expires 0 612 812
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(Si ure of N lic- State of Florida )
(S' ature f ry P
mmission _ (Seal)
o fission N0 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
COMPLETED
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