HomeMy WebLinkAboutBUILDING_PERMIT APPAll APPLICABLE INFO? MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 05/20/20 Permit Number:
C0(JNTY
F L O R 1 C
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT TYPE: PLUMBING
PROPOSED IMPROVEMENT LOCATION:
Address: 5716 BIRCH DR
Property Tax ID #: 3402-609-0409-000-9
Site Plan Name:
Project Name: WATER HEATER REPLACEMNT
Commercial Residential X
DETAILED DESCRIPTION OF WORK:
50 GAL ELECTRIC WATER HEATER REPLACEMENT
CONSTRUCTION INFORMATION:
Lot No. 11
Block No. 63
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: $ 1550.00
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: — Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Kevin Pude
Name: RICHARD BASSOFF
Address: 5716 BIRCH DR
Company: ADMIRAL PLUMBING SERVICES, LLC
City: Fort Pierce FL State: _
Zip Code: 34983 Fax:
Phone No. 561-574-9473
Address: 2895 JUPITER PARK DR STE 700
City: JUPITER State: FL
Zip Code: 33458 Fax:
phone No 561-746-1180
E -Mail: kpude5716@att.net
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail 208PERMITfING@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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF OMIMENCEMENT."
ev. 1
Signature of Ow er/ L ssee/Contractor as Agent for Owner
Signature of C ntra or/License Holder
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 before me
this 20TH day of MAY 20 by
this 20TH day of MAY 20 -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 Identification
Produced
Produce
(Si ')ature of N ry Pub - e o
A htotary Public State of Florida
(Si nature of otary Public- Stat oa Notary Public State of Fla
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C mission N e NIC
Jacqueline Georgescu
Commission SLICarnmission GC 2331
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Expires 0612812022
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ExO3 res 0612612022
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ZONING
SUPERVISOR
PLANS
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MANGROVE
COUNTER
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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