HomeMy WebLinkAboutBuildingPermitApplication - PlaAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/2/2021 Permit Number:
T. LlIC1E
A
OCI�I THY
D
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
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 9101 S Indian River Dr.
Property Tax I D #: 3519-505-0003-010-6
Site Plan Name:
Project Name:
Residential x
Lot No. 1 &2
Block No.
DETAILED DESCRIPTION OF WORK:
Relocate kitchen to existing dining room space. Addition of bathroom in existing kitchen space.
Install trim and fixtures.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 8,766.30
Gas Piping
Sprinklers
Shutters _ Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Evelyn Pla
Name: Adam Sampson
Address: 9101 S Indian River Dr.
Company: Southpaw Plumbing & Metering Svcs, LLC
City: Fort Pierce State: _
Zip Code: 34982 Fax:
Phone No.
Address: 1458 SW Bartell Ave.
City: Port St. Lucie State: FL
Zip Code: 34953 Fax: 772-324-6531
Phone No 772-486-0914
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail info south pawwater.com
State or County License CFC1428285
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:
Not
MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worl<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
I.,;+t, ie..ao, n, �n nt1- ,rn=%/ F,PfnrP rnn,n,Pnrina work or rerordine your Notice of.Commencement.
Signature bf Ownerr/ Less ntractor as Agent for Owner
Signature of Contractor tense Holder
STATE OF FILCOUNTY �CD�
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Swo n to (or affirmed) and subscribed before me of
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Swo to (or affirmed) and subscribed before me of
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Name of person making st tement.
Name of person making statement.
Personally Known Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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State of FI
Notary Johnson
Para JohflSon
Commission No. r�Sgalltycommission HH 036
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Kev. b/b/LU