HomeMy WebLinkAboutBuilding Permit Application Oct 151509:53a Jensen Beach Plumbing 772-225-6779 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /!�/ Q n
Date: IS"- S--
Permit Number: Cp
OCT 15 2015
Building Permit Application
Planning and Development Services
Suilding and Code Regulation Division
2300 Virginia Avenue,fort Pierce FL 39982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential XXX)cXXXX
PERMIT APPLICATION FOR: Other
PROPOSED IMPROVEMENT LOCATION:
Address: 17 Lake Vista Trail Unit 104
Legal Description: Vista St Lucie Bldg 17 Unit 104(or 3496-2451:3503-10237: 3513-656)
Property Tax ID#: 3422-500-0228-000-4 Lot No.
Site Plan Name: D&D National LLC(Joe DeFrancesco) Block No.
Project Name: D&D National LLC(Joe DeFrancesco)
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: '
Furnished and installed Rheem 30 gallon low boy water heater in closet under a/c system
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit—check all that appy:
HVAC Gas Tank E]Gas PipingShutters Q Windows/Doors
nGenerator
ILLY
Electric Plumbing Sprinklers Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 855.00 Utilities: Sewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameName: Lonnie Culberlson
Address: U ti Company: Jensen Beach Plumbing
City: P State:E:L Address: 1086 NE Industrial Blvd
Zip Code: 3qqf5QL Fax: City: Jensen Beach State:FL
Phone No.IaN�—QI�5- Zip Code: 34957 Fax: 772-225-6779
E-Mail: Phone No. 772-225-6600
Fill in fee simple Title Holder on next page(if different E-Mail: renee-jbplumbing@_bellsouth.net
from the Owner listed above) State or County License: FL#RF11067372
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Oct 1515 09:54a Jensen Beach Plumbing 772-225-6779 p.3
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 TITLEHOLDER: _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 County makes no representation that is granting a permit will authorize thepermit 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 recording our Notice of Commencement.
_Signature of Owner/Lessee/Agent Si nature of Contractor/License Holder i
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF M A e7 i K COUNTYOF Aih'T)(V
The forgoing instrumgnt was acknowledged before me The forgoing instrument was acknowledged before me
this qGday of *k2fL, 20 5—by this i5't day of �1L`fC)QC'C' .20 15 by
t;,nn iL-,. C. 1 iX,�tst:1J L-(nni(- ("u, I hciftt� n
(Name of person acknowledging) (Name of person acknowledging)
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(Signat re of No ry Public-State of Florida i0iture of IWtary Public-State of Florida
/ N F WILSON
Personally Known—' Personally Known 0 "i3lbf�1Y€e �g� �i�7�
Type of Identification Produ d'" �v"',. y e of Identification Pro = _
r— I Fr: t "''•dor r� E�' 2818
Commission No. 1` r l^ o a aMMISSION#FF159 Ido mission No. �15 9e�'� ntervServlceX0M
t �d�r' I ES November 8,2 18
(ao�7 398-0153 FloridallofaryService.cam
Revised 07/15/2014
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