HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 04/01/2015 RECE1'71) p Permit Number:
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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 Residential
PERMIT APPLICATION FOR: Plumbing
PROPOSED IIVIPROUEMENT LOCATION
Address: 9550 S Ocean Drive #1003 Jensen Beach, FL 34957
Legal Description: Island I Condo Unit 1003
Property Tax ID#: 4502-601-0087-000-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED NO
DESCRIPT(O . F"WOR.'/"-x= 't
_
Remove walk in shower and replace with tub.
C(JNSTRUCTi(JN INFORMATION 4
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Additional work toe e Orme un er t is permit—c ec a appy:
HVAC 11 Gas Tank E]Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 50 SFt.of First Floor:
Cost of Construction:$ 3295.00 Utilities:)Sewer El Septic Building Height:
OWNER/LESSEES CONTRACTOR _
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Name Rosemary Mazur Name.
Lt l.m YY1 dYi�-
Address:9550 S Ocean Dr. #1003 Company: �W_ A)3 r" to 1!14
City: Jensen Beach State:FL Address: �0 6cy- 136
Zip Code: 34957 Fax: City: 3<,nSZnn Pa a(,!J State: L
Phone No.772-485-5184 Zip Code: -r' �j� Fax:
E-Mail: Phone No. r36-4-1
Fill in fee simple Title Holder on next page(if different E-Mail: ' �lK-A p\uM hi!�5 (M do 1 • (.oyyi
from the Owner listed above) State or County License:'CJC%L 14 2 6"1 1!,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: )C 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
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 rec our Notice of Commencement.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OY FLORIDA
COUNTOF
COUNTY OF D
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this U day of D yi 1 20 IS by this 6 day of vi ll 20 !S by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known X OR Produced Identification Personally Known \-' OR Produced Identification
Type of Identification Type of Identification
Produced 1�DEENEDOD �p5 Produced
Commission#EE 25 2015 K, MOM.0.- 465 5
*: Expires eptember 1o�e Commission No. r •�
Commission No. 'b: BOWm,(, trg6 t�t��n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.