HomeMy WebLinkAboutBuilding Permit Application Sep 2815 07:59a Jensen Beach Plumbing 772-225-6779 p.1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:0'\ 01� Permit Number._\5GI a y 3j
S, J
® RECEIV'7D SEP 2015
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential XXXxXxXX
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line wq 'r
hR a e
PROPOSED IMPROVEMENT LOCATION:
Address: 10680 South Ocean Drive Unit 509
Legal Description: Island Crest Condo Unit 509 abd UNDIV Share in Common Elements(or 3184-563:3413-2352)
Property Tax ID#: 4511-516-0056-000-2 Lot No.
Site Plan Name: Jerry D Butler Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
supplied and installed a Rheem 30 gallon lowboy
CONSTRUCTION INFORMATION:
Additional work toe e orme under tis permit—c ec a apply;
aHVAC 13 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
aElectric FV71 Plumbing OSprinklers FIGenerator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction;$ 900.00 Utilities:Sewer 0 Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name ' - r ' Name: -
Address: > -) e) (1f;nn Company. t j f!
Citr,12 1�' ' L) El State: ___ Address: W- ` 0 � 1
Zip Code: Fax: Citjr; =f1 ~�_ State:
Phone No. Zip Code: Fax:1 'D
E-Mail:( a Phone No.
Fill in fee simple Title Holder on next page(' dWerCg�r t , -Mail:
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Sep 2815 08:00a Jensen Beach Plumbing 772-225-6779 p.2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:-
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counmakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in coAct 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 our Notice of Commencement.
_Signature of Owner/Lessee/Agent . Signature of Contrdha—r/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF )M(3 rL n COUNTY OF MQLY Irl
The forgoing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2,!�day ofQg42t-QM1oi,y—. 20 IS:-by this9,1�_day of. �&ntern 1Qj r .20 (S by
(Name of person acknowledging) (Name of person acknowledging)
gnature o34otary Public-State of Florida) " nature o otary Public-State of Florida)
Personally Known_�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No: j-'E! ommission No. F'_SCi .TPcG�YN wlLSON
SACLYN F WILSON ;
hSION FF15977 Nty COMIAISSION#FF159771
EXPIRES November a.2016 oyerr:
Revised 07/15/2014 °="'
(07)39"153 F1c�idatdOtaryService,eort:. t4071308 0153 Fli:ne:::Ntr:;i:y5eNice.cOrA
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS