HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: `J I _31—
RE CE IV E D
Building Permit Application DEC 15 2015
Planning and Development Services PERtAITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Plumbing 0
PROPOSED IMPROVEMENT LOCATION:
Address: 841 SE Solaz Ave Port St. Lucie, Fl. 34983
Legal Description. RIVER PARK-UNIT 6-BLK 61 LOT 13(MAP 34/28S)(OR 201-1168)
Property Tax ID#: 3419-545-0092-000-0 Lot No.13
Site Plan Name: Block No. 61
Project Name: Keith Fultz
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace Guest Bath shower valve
CONSTRUCTION INFORMATION:
Additional work oorme under this perms —c hecka appy:
❑HVAC fl Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
iJ Electric 0 Plumbing Sprinklers F�Generator F�Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ���; Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameKeith Fultz Name: Joseph F.Tully
Address:841 SE Solaz Ave Company: Genesis Plumbing Services Inc.
City: Port St. Lucie State:FI Address: 1902 SE Bolton Ave.
Zip Code: 34983 Fax: City: Port St. Lucie State:FI
Phone No.772-878-1421 Zip Code: 34952 Fax:
E-Mail: Phone No. 772-337-3682
Fill in fee simple Title Holder on next page(if different E-Mail: GENESISPLUMBINGSERVICES@GMAIL..COM
from the Owner listed above) State or County License: CFC1429103
N value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 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 recording our Notice of Commencement.
S
gnature of Owner/Lessee/Agent gnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFst-w- COUNTY OF&Mucro
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this��day of���,c.k,. �—. 20 by this day of r'`� r 20 f 5—by
.Jzy3�p4-,
(Name of person acknowledging (Name of pers n acknowledging)
(Si ature of Notary Public-State of Florida} (Si tune of Notary Public-State of Florida}
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produ T pe of Identification Pr
► KAYLA ALLEN
Commission No. Yov �g tea mmission No. "/ •Y MY G >�10�1�
slaw 01.2019 EXAM$8epWrAw 01,20"
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS