HomeMy WebLinkAboutbuilding permitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3�2.&J_ZOZO Permit Number:
1110 NUM W 511111111�-
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: 9409 S OCEAN DR 27
Legal Description: 35 36 41 (ISLAND VILLAGE PHASE 11 BLDG 1 UNIT 27)
Property Tax ID #: 3535-333-0001-010-5
Site Plan Name:
Project Name: SIMPSON
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
38GAL ELEC WATER HEATER REPLACEMENT
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be rformed under this permit —check all apply:
11HVAC �] Gas Tank []Gas Piping Shutters Windows/Doors
11 Electric Ez Plumbing OSprinklers G e ne rato r 0 Roof Roof pitch
Total Sq. Ft of Construction:.
Cost of Construction: $ 1176
S Ft of First Floor:
Utifities'n Sewer []Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ronald L Simpson
Name: DIMITRE BOBEV
Company: FLORIDA DELTA MECHANICAL
Address: 9409 S OCEAN DR 27
City: JENSON BEACH State: FIL
Zip Code: 34957 Fax:
Phone No. 847-514-0872
Address: 8402 LAUREL FAIR CIR 111
City: TAMPA State. FIL
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 is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zi p: Phone
City: State:
Zi p: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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
which is in conflict with any applicable Home Owners Association rUes, 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 ko your property. A Notice of Cqmmencement must be recorded and posted on the jobsite
bef ore the fir'6.."t iNspecti+. if y intend to oKtain financing, consult with lender or an attorney before
commencing�wotk,or redordi aouVhotijz� of Commencement..
A /I k"": A -V Vo
�
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signatu4-Wf dontract'WL—icenVe Ho`tde�
STATE OF FLORIDA
He
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The ftge;ing instrument was acknowledged before me
The fo?rgoing instrument was acknowledged before me
—4Wday
this_ ayof_MC(V-CJ�]—,26'2-0by
this of YYVI!1Q1 20_U by
Unictyc 6c)beAj
D ( M I "t)-Q t3cj b"
Name of person making statement
Name of person making statement
Personally Known Q( OR Produced Identification
Personally Known - (A OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
&,414 ��
(Signature of N ary P
(Signature
EMILY H. MEDINA
my CON4 SION # GG 227056
Commission No.
Commission MY COMMISSION # %227�5.6
EXPIRES: Juna 11, 2022
Bmded Thru Notary Public Underwrite rs
S.
.'.P; Bondul Thru Notary Public Underwriters
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DATE
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DATE
COMPLETED
Rev. 8/2/17