HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: � S(n— ® � f
1T-D JUL 0 9,2015
Eli •
- — 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: To Select from dropbox, click arrow at the end of line
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ROPOED IMMPRO\/tEMENT�LOCdTION � �4 � � � taw mer, t ;� q �.
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Address: 5512 CASSIA DRIVE FT PIERCE FL 34982
Legal Description: INDIAN RIVER ESTATES UNIT 09 BLOCK 72 LOTS 18 AND 19(MAP 34/12N)(OR 1063-277)
Property Tax ID#: 3402-610-0076-000-9 Lot No. 18 AND 19
Site Plan Name: Block No. 72
Project Name:
Setbacks Front Back: Right Side: Left Side:
INSTALL NEW WATER SERVICE PIPING FROM NEW INSTALLED WATER METER TO HOUSE.
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Additional work toe Dertormea under this permit—check all appy:
HVAC 0 Gas Tank F]Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers El Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ 450.00 Utilities: Sewer OSeptic Building Height:
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Name VALERIE A NIEWIEROSKI Name: RONALD E MEEKS ,
Address: 5512 CASSIA DRIVE Company: MEEKS PLUMBING INC
City: FT. PIERCE State: FL Address: 5555 US 1, SUITE 1
Zip Code: 34982 Fax: City: VERO BEACH State:FL
Phone No. 772-466-3437 Zip Code: 32967 Fax: 772-5697647
E-Mail: Phone No. 772-569-2285
Fill in fee simple Title Holder on next page(if different E-Mail: INFO@MEEKSPLUMBING.COM
from the Owner listed above) State or County License: CFCO24535
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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cDESIGNER/.E.�..-NNE.'F,..G/T}.F.t.s�AIr xNE.C.eEwuR.i:^�Y,NFtrSx..,•.Tsx�-c:G:R. U.iSiFFCt.'""T�`..Iac.Q.'�"*r[",U°;i;.fL:r;l+E.�,N����,-�Ltr^A:t+^TrWr.s"Ck.n.�'1.Ndaf..'�y Fmi.Q.�x'xnsR�tMs,I'nU�.WilA�t�T1''nxsI'rQ{•.it*Y:;'LN�r!F%i'°:,?G,rG.�`'a-,.,xtxt«rr#pYar-zSrsk}�.g.t.:t,.,R,,s�,q3r;�.sa-ke.�7;4J.,j:",5v-_s tk.�`,c:."..fs s�-�+...".`jY i.ir�a."x,.>r wt'$�."rt4```��'c
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x Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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
e o the first inspection. If you intend to obtain finan , consult with lender or an attorney before
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omme cin work or recordingour Notice of Commen em t.
_Signature of OwnJ Lessee/Agent Signature of Contractor/ icense Holder
STATE OF FLORI �A ,S. STATE OF FLORIDA
COUNTYOF_ _ � y�� 1 GG4c.�QJ— COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 _by this day of 20 by
(Name of person cknouvledgIng) (Name of person acknowledging)
r
(Sign ture ry ubli tate of Florida) ``,(Signature N t Public-State of Florida)
Personally Known OR Produced Identification iR rso y Known OR Produced Identification
Type of ldentificati roduced Type of Identification Produced
Commission No. I Commission No. LORETTAM. ULT:, rs
L01104 .68AULT ARY
NOTARY PUBW STATE OF ROR 1
Revised 07/25/201 ). C4Mrn#FF038316 Expires 811012017
Explm 8/10/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS