HomeMy WebLinkAboutBuilding Permit Application �►�''zC�PLI��BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 15-1- o,Date: i OAX15 Permit Numbe0 'x
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RECEIVED
Building Permit Application
Planning and Development Services OCT
16 205
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Plumbing
PROP OSED,IMPROVEMENT LOCATION. _
Address: 8650 South Ocean Dr Unit 203
Legal Description: UN LN-3 BLD 1 Regency Island Dunes 1
Property Tax ID#: 353450100030008 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O'FV OKK
Installed Rheem 40 gallon tall electric water heater and replace shut off valve.
CONSTRUCTION]NFORMATION
Additional work toe e ormer n 'un er!his permit—check a app y:
HVAC 11 Gas Tank ❑Gas Piping IShutters Windows/Doors
Electric 0 Plumbing OSprinklers E Generator g Roof
Total Sq. Ft of Construction: 5 Ft.of First Floor:
Cost of Construction:$ 945 Utilities []Sewer�Septic Building Height:
OWNSR/LESSEE CONTRACTOR:
Name John Berthoud Name: Dale Hammond
Address:8650 S Ocean Dr Company: For Him Plumbing
City: Jensen Beach State:FL Address: P O Box 1355
Zip Code: 34957 Fax: City: Jensen Beach State:FL
Phone No. 772-229-8996 office#772-229-0311 Zip Code: 34957 Fax:
E-Mail: jberthoud@msn.com Phone No. 772-342-8677
Fill in fee simple Title Holder on next page(if different E-Mail: forHimplumbing@aol.com
from the Owner listed above) State or County License: CFC1428915
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:,
DESIGNERAENGINEER: Not Applicable MORTGAGE COMPANY: ig'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 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 recordimvour Notice of Commencement,
nv—/ s
_Signature of Owner/Lessee/Agent Signature ofontrac or Lic se Holder 5531
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF �r�,tl COUNTY OF-&Ad=n tJ
The for&oing instryment was acknowledged before me The forgpling Instrument was acknowledged before me
this day of 20 L( 'by this J�ffday of CeZ�Ce2 .20 /S—by
(Name of person acknowledging) (Name of person acknowledging)
(Sig azure o otary Public-State of Florida) (Si ure of Notary Pu c- t of Florida)
Personally Known OR Pro�((�ee�!dentification Personally Known OR Produced Identification ✓
Type of Identification Produced �'I..1.11r Type of Identification Produced__ 6~[ t__-
CommissionNo.v.C.,l ag Y11s all moNIQUE M.CARLO!ComisslonNo.gEg81Egi� (Seal)
Notary Aubllc,Stats of FI ride
Commission}+FF 182417 pyg�
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Revised 07/I5/201� & µ�HPublio,�
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DATE
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INITIALS
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