HomeMy WebLinkAboutApplication Prefab Plumbing Travis SLCAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
L IE
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
PERMIT APPLICATION FOR:I7lUCTlI inq I
Address: 2203 Jo Haywood Dr Fort Pierce, FL 34946-1627
Property Tax ID #: 1432-700-0027-000-4
Site Plan Name: CITRUS HEIGHTS S/D
Project Name: Travis
Install Shower new Shower Pan
New Electrical Meter Second Electrical Meter
Lot No. 24
Block No.
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 1700.00
Name Mamie Lee Travis
Address: 2203 JO HAYWOOD DR
City: Fort Pierce State:
Zip Code: 34946 Fax:
Phone No. 772-405-0117
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Michael Coleman
Company:Prefab Plumbing Inc
Address: 1100 Carr St
City: Palakta State: FL
Zip Code: 32177 Fax:
Phone N0386-546-7643
E -Mail mgc1980@gmail.com
State or County LicenseCFC043003
f vaiuc of rnndmhinn is 78nn nr mnre_ a RFCf)RDFD Nntice of Commencement is reauired
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name: — -----
Address.
---•Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name: Not Applicable
Address:
City -
Zip: Phone:
MORTGAGE COMPANY:
Name: Not Applicable
Address:
City: State:
ZIP: Phone:
BONDING CompANY:
NI.,. -
Not Applicable
Address:
City:
Zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noyywork or installation has commenced prior to the issuance of a permit.
wthichis in con, list awith any applicable )Home Owners Association) rulels abylaws or andpcovenants that malyr estrictbor prohibits ch
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before Commencing work or rernrriina :__ _L
� ldlry¢,
SignaY are of Owne ssee/Contractor as Agent for Owner
STATE OF
COUNTYOFO� k�
Sworn to (or affirmed) and subscribed before me of
Phy 'cal Presen or Online Notarization
th's day of d 2020 by
19 t4 1 /
Name of person making statement.
Personally Known __-4I.Produced Identification �
Type of Identification,
n, \
Signature of Contractor/License Holder
STATE OF FLO,R �9�
COUNTY OF/
Sworn to (or affirmed) and subscribed before me of
_ Physical Presence or Online Notarization
this day of_ 7— 2020 by
Name of person making statement.
Personally Known %/AOR Produced Identification
Type of Identif 'oledi onn
KATHRYN POCKER
( ignature of No Ijp
•p; Notary Public - State of Florida
a; Commission # HH 025227
Commission No.
WTHRYN POCKER
j Notary Public -State of Floridao�
Ignature f N Public
t tQaM . xPires ov 21, 2024
(rou§h National Notary
lhsion # HH 025227
My
Commission No.
Assn.
Comm. Expires Nov 21, 2024
®efidod through National Notary
(Seal)
Assn.
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