HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONMar 031511:54a CRSPlumbir,z
770-460-7774 p.4
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j� ��Q�
Date: SCANNED Permit Number: / 5) 3• � =N /
BY
s _ St. Lucie County
• Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial xxx Residential
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 1203 Midway Rd
Legal Description:
Property Tax ID #: 3404-501-0340-DOO-2
Site Plan Name:
Project Name:
Setbacks Front Back:
RightSide: LeftSide:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: III
Replace water main piping with sched 40 in order to get out of ROW
I CONSTRUCTION INFORMATION: III
LJ Gas Tank UGas Piping
0 Plumbing [:]Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 9S0
Shutters ❑Windows/Doors
Generator ®Roof
5 Ft. of First Floor.
UtilitiestSewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Diana Evans
Name: Reed Sudderth _
Address:1203 Midway Rd
Company: CRS Plumbing
City Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No.772-468-299B
Address: P.O. Box 12755
City: Fort Pierce State: FL
,Zip Code: 34979 Fax: 772-460-7774
Phone No. 772-466-7763
E-Mail:
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
E-Mail: crsplumbing@bellsouth.net
State or County License: CFC1426853
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Mar 031511:54a CRSPlumbirn
779-460-7774 p.5
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: II
a�aw.cn�craon�ocn: _rvoc Appucaoie MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone- Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY- _Not Applicable
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count. makes no representation that is granting a�]ermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home OwnersAssoc`atlon rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St Lucie County Amendments.
The following building permit applications are exempt from undergoing a full conmrrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with ler er or an attorney before
Lessee
STATE OF FLORIDA
COUNTY OF P S[ Luco
The forgoing instrument was acknowledged before me
this 3 day of MAR 20 ffby
E*r d D. Jendrnl-
(Name of person acknowledging )
Known
Type of Identification Rio fA . -.
k' o" —i EXPIRF�$ VaIEy 19, 2018
Commission No. +-••w•• na
Revised 07/15/2014
Signature of contractor/license Holder
STATE OF FLORIDA
COUNTY OF Pa, ---
The forgoing instrument was acknowledged before me
this•J_dayof MAfA .20JIby
Edward 0. Jmdon
(Name of person acknowledging)
(' nature of Notary Public-5 ate f Florida )
Personally Known x ��So. ce�
Type of Identification Pro ''d'r"•i'�': aN
t`o. ai111124567
Commission No. \�a•„!;°�r'F EXVSRf; May 19, 2018
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