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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: June 27, 2017 Permit Number: 0_1 .0) _1f
r V7
BuildingPermit Application ElVED
Planning and Development Services
Building and Code Regulation Division JUL 1 I ?h17
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPO$ED IM;PROVEMENT LOCATION:
Address: 10618 Pine Needle Drive, Fort Pierce, FL 34945-2200
Legal Description: PINE HOLLOW -UNIT TWO- LOT 5 (1.037 AC) (OR 3965-277)
Property Tax ID #: 2321-802-0007-000-3
Site.Plan Name:
Project Name:
Setbacks Front Back:
Relocating Gas Dryer
Right Side
Left Side:
CONSTRUCTION J N FORMATION
d Additional work to be nertormed under this permit — check a apply:
�HVAC Gas Tank W]Gas Piping Shutters
Electric ❑ Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 300
S Ft. of First Floor: _
Utilities:Sewer Septic
Lot No. 5
Block No.
QWindows/Doors
ElRoof Roof pitch
Building Height:
OVtIN ER/LESSEE:
CONTRACTOR:
Name Leslie Crippen
Name: Wade D Case
Address: 10618 Pine Needle Drive
Company: Lindquist Plumbing & Supply, Co., Inc.
City: Ft Pierce State: FL
Zip Code: 34945 Fax:
Phone No.
Address: 3185 Sneed Road
City: Ft Pierce State: FL
Zip Code: 34945 Fax:
Phone No. 772-461-1969
E-Mail: Lindquistplumbingcompany@Gmail.com
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CFC1428458
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip: Phone:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 vour Notice of Commencement.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF J� �V L •� e
The forgoing instrument was acknowledged before me
this�i day of y\ C 20 [a -by
(Name of person acknowledging )
(Sig ature of NotaryPuPublic- State of Florida )
Personally Known" OR Produced Identification
Type of Identification Produced
Commission No. (Seal)I ;;:= MIC
� ill MY Co
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF eJr Luca -e_,
The forgoing instrument was acknowledged before me
thisA'-) day of P—, 20 F1 by
(Name of person acknowledging)
Personally Known v OR Produced Identification
Type of Identification Produced
# GG055253
(Seal)
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