HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL All 7117 PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date Permit Number:
QUAMTED
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Building Permit Application &Ind AM 9.0'
Plannin
g ng and Development Services
Builr/16 and Code Regulation Division
23066rginia Avenue, Fort Pierce FL 34982
Phonle: (772) 462-1553 Fax: (772) 462-1578 Commercial
Tan4ess
Permitting Dep 'tm
St. Lucie Co my
Residential I
I PERMIT APPLICATION FOR: Plumbing I
ED, MIMI' ' EMI,
QPICI$ 'I 1. AT
��R'J` ENT Lbt
Addre s. 282 NE Summer Road, Port,St. Lucie, FL 34983
Legal Description: RIVER PARK -UNIT 9-PART C BLK 79 LOT 2 (MAP 34/21S) (OR 3095-1740)
Site P
Tax ID #: 3419-570-0058-000-8
Name:
ame:
Lot No. 2
Block No. 79
Setbls Front Back: Right -Side: Left Side:
DETA�LED DESCRIPTION -RIPTIO S
0, j ec Ct r coo m e-_
cuy-)a cy, 4-an vAp- s s ho
Lo Cafi'()Y'1' Rec, 0 I44_S60 >
CONS"
io INF R ATION:,'
T " RUC
-Additi pal work to be nertormed Gas Tank underthisper it—checkall a p p Fy—.
IVAC 11 Gas Piping Shutters E]Windows/Doors
El
i
Electric 01 Plumbing [_]Sprinklers Generator Roof Roof pitch
11 4
Total S11. Ft of Construction: S Ft of First Floor: _T, _1 '$ i S-00, ev lil
Cost of IF onstruction: Utilities.. —Sewer Lj SepticBuilding Height:
OWN E#/'LESSEE
TRACT
CONTRACTOR
"N
Simone Simone
Name: Jason Sessanna
Company: Thermal Water Works LLC
Address�l: 282 NE Summer Road
City: 61rt St. Lucie State: FL
Zl1p'CoJ1e: 34983 Fax- n/a
Phone No 772-626-5015
E_Mail:l stardancetc@gmail.com
Fill-in f 11 simple Title Holder on next page (if different
'T
from th Owner listed above)
Address: 282 NE Summer Road
City: Port Saint Lucie State: FL
Zip Code: 34983 Fax. n/a
Phone No. 772-528-5933
E-Mail: jason.sessanna@gmail.com
State or County License: CFC1428176
If value Of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPIPLEMENTAL CONSTRUCTION LIEN1A1N INF;ORNIATION
'DESIGNER/ENGINEER: Not Applicable n MORTGAGE COMPANY: Not Applicable
'Narr�e: Name:
Address: Address:
City: 1 State: City: State:
Zip: I Phone Zip: Phone:
I
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: VNot Applicable
Name: Name:
Address: Address:
city: I City:
Zip: II Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certif that no work or installation has commenced prior to the issuance of a permit.
St. Luci County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which ig in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structu e. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In cons;deration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acco�dance 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
WARD ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improli ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
beforellthe first inspection. If you intend to obtain financing, consult with lender or an attorney before mlen comcin work or recording our Notice of Commencement.
S' a ire of Owner/ Lessee/Contractor as Agent for Owner Signa re of Contractor/License Holder
STALE OF FLORIDA STATE OF FLORIDA
COU TY OF I ,a ,✓ae COUNTY OF IYIY1 Yu e
The f rgoing instr ment was acknowledged before me The for oing instru ent was acknowledged before me
this �4-day of 20& by this May of 1n s 20 /$ by
I
010
OL �Q ar) 51, S Cra h nQ
Name of persoq making statement Name of person making statement
Perso ally Known ✓✓ OR Produced Identification Personally Known OR Produced Identification
Type Qf Identification Type of Identification
Produced Produced
(Sign l Iture of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Commission No. S; �,�(Seal)�g Commission No.`(Seal)' �~
i <Com '.ssson 8 GG W318
rur�;o t UG OE1318
t.�ar 30, 20--1
x ' =air„ tnvF is Ls rnce 800.- 57019 I ; ,': °' B,,dnd T . Troy Fain Insurance 800a85 7019i
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Rev. 8/2/17