HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/23/20
COUNTY
F 1 O R I C
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: PLUMBING
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential X
Address: 8031 Plantation Lakes DR Saint Lucie West, FL 34986
Property Tax ID #: 3321-803-0048-000-8
Site Plan Name:
Project Name: WATER HEATER
DETAILED DESCRIPTION OF WORK:
50- GALLON ELECTRIC WATER HEATER REPLACEMENT
CONSTRUCTION INFORMATION:
Lot No.
Block No.
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: $ 1,421.00
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Mark D Roberts
Name: RICHARD BASSOFF
Address: 8031 Plantation Lakes DR
Company: ADMIRAL PLUMBING SERVICES, LLC
City: PORT SAINT LUCIE FL State: _
Zip Code: 34986 Fax:
Phone No.251-643-3113
Address:2895 JUPITER PARK DR STE 700
City: JUPITER State: FL
Zip Code: 33458 Fax:
Phone No 561-746-1180
E-Mail:-mdrroberts@bellsouth.net
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: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
23
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
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 YOU"ENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Les ee/
tract as nt for Owner
(�
Signatu24�;�
re of Contractor/License�y d
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,pefore me
this 23RD day of JAN
. ZO J by
this 23RD day of JAN . 20ZV1 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 Identification
Type of Id e tification
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