HomeMy WebLinkAboutBuilding permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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 x Residential
PERMIT APPLICATION FOR: Plumbing
Address: 9450 Meadowwood Dr # 102 Fort Pierce, FL 34951
Legal Description: 1327-703-0026-000-3
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Block No.
Install customer supplied 40 gallon water heater. (�.le <=1-Y1(:, W0�-i�-Y �'1C'_n Wr
'+uuuwnm wuin w uc nunncu unuei uiu pennu —uietrc an eppry:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑ Electric Z Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 415.00 Utilities:)Sewer ❑Septic Building Height:
Name Rony Kessler and Ana Kessler
Address: 9450 Meadowwood Dr # 102
City: Fort Pierce State: FL
Zip Code: 34951 Fax:
Phone No.516-369-2376
E-Mail:
Fill in
fee
simple
Title Holder on next page
(if different
from
the
Owner
Ilsted above)
Name: Gary W. Evers
Company: First Quality Plumbing
Address: 746 N. Volusia Avenue
City: Orange City State: FL
Zip Code: 32763 Fax: 321-610-3919
Phone No. 321-253-3939
Mail: palmbayservice@fgplumbing.com
State or County License: CFC050566
If value of construction is $2500 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: Applicable
Name:
_Not
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 Count yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 ins ecti wirrtepd to obtain financing, consult with lender or an attorney before
commencin wor erIn o r Notice of Commencement.
Signatu a of Owne Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF i5
COUNTY OFF/'S 0jk41AXd
The fo{going instrument was acknowledged before me
thiiss �, & day{ o/f MA rnln 20?vD by
The for ng instrument was ac owledged before me
this ay of A-R 20 2 ) by
K.CWI I'C SS ke
6A.Ct4 JA E A1,4 JCAIJFX S
'Name of person making statement
Personally Known OR Produced Identification
Nanhe of perso aking statement
Personally Known V OR Produced Identification
_
Type of Identification
Produced Do L. " /q 5 "7 J 3? Lo53
Type of Identification
Produced
(•
19ni ture of Notary Pu
(Sfinaturqo Notary P hlic..5faieo#-Flerid
Notary Public State w FWW
Luc! core;F•�.Commission No. `t`"t �My Cwion GG 2NO04
pi(4(, (�$ pL( E piree 01730/2023 I
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Al""l.GAY SODDY
Commission No. • : My COM(yg@$ION k FF979712
o tlok EXPIRES April 06. 2020
(407) 39"163 FlwldeNdJ BBMca.caa
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17