HomeMy WebLinkAboutApp Plumbing - JacobsenAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Plumb
Address: 5309 Deer Run DR
Property Tax ID #: 1313-502-0034-000-2
Site Plan Name:
Project Name: Jacobsen
Remove existing tub and install new walk-in tub. NO tile or drywall work being done
New Electrical Meter Second Electrical Meter
Lot No. 457
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 Marcine Jacobsen
Address: 5309 Deer Run DR
Sq. Ft. of First Floor:
Utilities: -Sewer _Septic Building Height:
City: Fort Pierce State: _
Zip Code: 34951 Fax:
Phone No. 712-260-2112
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Michael Coleman
Company: Prefab Plumbing
Address: 1100 Carr St
City: Palakta State: FL
Zip Code: 34951 Fax:
Phone N0386-546-7643
E -Mail mgc1980@gmail.com
State or County License CFC043003
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 Countv and posted on the iobsite before the first inspection. If you intend to obtain financing, consult
or an
41A
STATE O
COUNTY
as Agent for Owner
Sworn t r affirmed) and subscribed before me of
hysical Presence or Online Notarization
this a2 -day of 2020 by
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Name of person making statement
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Signature of Contractor/License Holder
STATE OF FLO A �,
COUNTY OF �� IAK�J
Sworn (or affirmed) and subscribed before me of
Physical Prese a or_Online Notarization
thhiisJo �daayoof7 //-J-- / �v1,
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Name of person making statement
Personally Known OR Produced Identificationy Personal
Type of Identifi ion y Type of I
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POCKER 1�igndture ur�rv`
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Commission No. ' s No� ]57222ptqCommission No.
Bondal Notary Assn,
Produced Identification
KATHRYN POCKER
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My Comm. Expires Nov 21, 2024
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