HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9/21/2020
Permit Number:
(D
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Plumbing
PR21?0§�?!MPROVEMENT LOCATION:
Address: 5018 Silver Oak Dr.
Property Tax ID #: 3402-606-0245-000-2
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Bathroom remodel with new shower valves.
New Electrical Meter Second Electrical Meter
CONSTRUCTION•R
Additional work to be performed under this permit– check all that apply:
Lot N0.25 & 26
Block No. 27
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric x Plumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction: 2,114
Cost of Construction: $ 2,400
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameWilliam Settle
Name Adam Sampson
Address:5018 Silver Oak Dr.
Com pa ny: Southpaw Plumbing and Metering Servic
City. Fort Pierce State: FL
Address:1458 SW Bartell Ave.
Zip Code: 34982 Fax:
City: Port St. Lucie State:FL
Phone No.772-252-5986
Zip Code: 34953 Fax: 772-324-6531
E-mail:wmrsettle@gmail.com
Phone N0772-486-0914
E-Mailinfo@southpawwater.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County LicenseCFC1428285
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
4
i
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 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 recording our Notice of Commencement.
Signature of Owner/ 1-61K/Contractor as Agent for Owner
Signature of Cont r/License Holder
STATE OF FLORIDA N
STATE OF FLORIDA
COUNTY OF Ti " Aelk
COUNTY OF - �IA0,1P
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
S orn to (or affirmed) and subscribed before me of
ji Physical Presence or Online Notarization
this f day of 2020 by
this tl day of E�Y , 2020 by
Name of person makkiin/g° statement.
Name of person making statement.
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Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identi cation
Produced_
Produced
(Signature of Notary Pu c!-eo, pri a
Pu lic State of Florida
(Signature of Notary Publo3ary Notary Public State of Florida
My c Bak#tion
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Commission No. GG 225242
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Commission NO. M ,oMy C �l�n GG 225242
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