HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/3/20 Permit Number:
O
° 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
VEMENT LOCATION:
Address: 8256 Sandpine Circle, Port St. Lucie, FL 34952
Property Tax ID#: 3426-703-0033-000-5 Lot No.19
Site Plan Name: Jurceka Block No.
Project Name: —
DETAILED DESCRIPTION OF WORK:
Remove existing tub and install new walk-in tub. NO tile or drywall work being done
New Electrical Meter Second Electrical Meter
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: Sq. Ft. of First Floor:
Cost of Construction: $ 1700.00 Utilities: -Sewer _Septic Building Height:
NameJohn A Jurceka Name: Michael Coleman
Address:8256 Sandpine CIR Company: Prefab Plumbing Inc
City: Port St Lucie, FL State:_ Address: 1100 Carr St
Zip Code: 34952 Fax: City. Palakta State:FL
Phone No.772-200-1081 Zip Code: 32177 Fax:
E-Mail: Phone N0386-546-7643
Fill in fee simple Title Holder on next page ( if different E-Mail mgc1980@gmail.com
from the Owner listed above) 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.
SUPPLEMENTA,t
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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
structure. Please consult any
Home Owners Association and reviebylaws
yo r deed for any restrictions may
maor
a prohibit such
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 attorneybefore commencingwork or record our Notice of Commencement.
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Sign ure of Own /Lessee/Contra"cto�r as Agent for Owner Signature of Contractor/License Holder
STATEOFFLORIDA
FLORID
OLJIV/GlJ COUNTY O FF
COUNT
Sworno(or affirmed)and subscribed before me of Swor (or affirmed)and subscribed before me of
_Physical Presence or Online Notarization Physical Presence or Online Notarization
this day of�'017— 2020 by this / day of �`.L� 2020 by
�oNi u/eC�K9— �'Ulefl�Q� Ago
IlVame of person aking statement. Name of person making statement.
Personally Known Produced Identification l/ Personally Known OR Produced Identification
Type of Identift �ry ProduceType of ldenY ation
Produced Ci
(Signature of I' "' of FlofflhR'N POCK ( ignature I
�. Notary public-state of Florida 1 A N
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commI,ts�llo��I r HIS 025227 f ,i, Notary Public-State of Florida
Commission No. My Comrt.�a�iljes Nov i1,2024 Commission ' Ion d HH 020M
Band ad through National Notary Assn. *. or n:' i4y Comm.Expires Nov 21,2024
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.