HomeMy WebLinkAboutMusselman AppALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T j 30L z o to 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 Residential X
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address. 4024 GREENWOOD DR
Legal Description: GREENWOOD BLK 1 W 80 FT OF LOT 12 AND ALL LOT 13 (0.58 AC) (OR 3775-984
Property Tax ID #: 2421-702-0013-000-8
Site Plan Name:
Project Name: MUSSELMAN
Setbacks Front Back
Right Side: Left Side:
Lot No. 12
Block No.
DETAILED DESCRIPTION OF WORK: 1
50 GAL ELEC WATER HEATER REPLACEMENT
CONSTRUCTION INFORMATION:
Additional work to b rtormed under this permit — c1e,1a11 apply:
0HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator 0 Roof Q Roof pitch
Total 5q. Ft of Construction: _
Cost of Construction: $ 1563
S Ft. of First Floor:
Utilities: Sewer O Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name CORY MUSSELMAN
Name:
Company: FLORIDA DELTA MECHANICAL
Address: 4024 GREENWOOD DR
City: FORT PIERCE State:FIL
Zip Code: 34982 Fax:
Phone No. 772-200-0729
Address: 8402 LAUREL FAIR CIR
City: TAMPA State: FL
Zip Code: 33610 Fax: 866-219-0729
Phone No. 866-219-0880
E-Mail: FLPERMITS@DELTAMECHANICAL.COM
State or County License: CFC1425917
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: CORY MUSSELMAN
Address: 4024 GREENWOOD DR
CItV: FORT PIERCE
Zip: Phone_
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: 8402 LAUREL FAIR CIR
City:
Zip: Phone:_
MORTGAGE COMPANY:
Name:
Address: 4024 GREENWOOD DR
City: TAMPA
Zip: Phone:_
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
_Not Applicable
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, 1 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
:ommenc work oq recoMing your NoJXe OT commencement.
r
�r= -V ��C) r D
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature C ntract /Licen a Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF COUNTY OF 14' S
The forgoing instrument was acknowledged before me The fArgDing instrument was acknowledged before me
this ' Q day of i�l�]l� I , 202.0 by this day of ig0ti' l 20`Ldby
ok MV 4c,
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
rm 02f�_ E50 blr, r _
Name of person making statement
Personally Known O�, OR Produced Identification
Type of Identification
Produced _.
dkQ-'
_&Wl'tA (Signature of N
ary
(Signature of No Public- St. of Florida
Commission No.
EMILY H. MEDINA
YC4MMI&OR#GG227056
a oG •... EMILY H. MEDINA
Commissio mdq ": A—SION#GG;&IId)
N.z EXpIRES:June 11,2022
�
�= EXPIRES: June 11, 2022
y FOF °p Bonded ihru Notary Public Undetwdters
F-c •Qe'
., ox4„ Bonded T11rU Notary Puhl{c Urtdenaitets
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17