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Home My WebLink AboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 12/29/2015 Permit Number: RECEIVED o",in"'i Building Permit Applicata®n DEC 3 0 2015 Planning and Development Services Building and Code Regulation Division PER?JUTTING 2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential XXxXXxxx VV PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line E C+CAT Address: 6105 Raintree Trail Fort Pierce, FL 34982 Legal Description: Indian River Estates Unit 09 BLK 71 LOT 34(MAP 34/11S)(OT 3614-2480) Property Tax ID#: 3402-610-0056-000-3 Lot No.34 Site Plan Name: Mr Staley(561-312-5144) Block No. 71 Project Name: US Bank NA 4801 Frederica St Owensboro,KY 42301 Setbacks Front Back: Right Side: Left Side: ;DETA[LED'DESCRfP�TIOIU0�I�IORfi f" ` � { _ `: Furnish & Install 40 gallon electric.tall water heater with expansion tank ;ORIUTAT(O � r -.GON'STR Additionalworkto e e orme un er t is permit—c ec a appy: Ll HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors F-7 Electric ®Plumbing Sprinklers 1:1 Generator F]Roof Total Sq. Ft of Construction: S Ft.of First Floor: Cost of Construction:$ C,, 1 .,...N:_..'r Utilities:D_Sewer O Septic Building Height: r; ;•;OWNER/LESSEE r Name tt Name: Lonnie Culbert son Address:> �i, Company: Jensen Beach Plumbing Stater". Address: 1086 NE Industrial Blvd Zip Code: ,f.," -'`t Fax: City: Jensen Beach State:F1onda Phone No. `_� ,; ?i ''i Kms•= Zip Code: 34957 772-225-6779 Fax: 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: 24654 if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 6'd 6LL9-9ZZ-ZLL 6ulgwnld y0e98 uasuaP 1309:9091.0E0e0 5, IRPLEt�/t t\tT } i r 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 commencingwork or recordingour Notice of Comm. nceme t-: i s Signature of Owner/Lessee/Agent //Signature of Cok—rktor/License W1631der STATE OF FLORIDA STATE OF FLORIDA COUNTY OF r' ,'2a,t V-�n COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this "'„__% day of 20 i zbythis 1 i day of 'i o_c ;r,i7�r, 20 1Z by 1 `,•ii:(\_.�.._i'. ��.a..l.l f:lii_F�'is.:.�'� I_.c�17Yl�i_.k ��J...l�LQti"I�.�GY'1 (Name of person acknowledging) (Name of person acknowledging) �r. (Signature;df Notary Public-State of Florida) (Signature of'Notary Public-State of Florida) Personally Known V" OR Produced Identification Personally Known %Z OR Produced Identification Type of Identification Produced Type of Identification Produced _ :,.IST ��j�p+)�/r�p p�9p�y LSE;N Commission No. f'F�S�i �P�a... (Seai)— �yl�g Fpmmission No. ri=i� X1'1 .�Se r: My COMMISSION#FFi 77 My COMMISSION#FF15 ;/, "',?o;�y"•` EXPIRES November 8, is "!aF�oef EXPIRES ovem er b, (407)398-0153 Flo ridallota yservice.co Revised 07/15/2014 (407139"153 FiorideNcnarYSMI L.cortt REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS Z•d 6LL9-9ZZ-ZLL bulgwnld g0e88 uasuap 1309:2091.0E 080 Jan 201610;44a Jensen Beach Plumbing 772-225-6779 P.1 Planning&Development Services Building& Code Regulations Division 2300 Virginia Ave. a b Fort Pierce,FL 34982 (772)462-1553 Fax 462-1578 CHANGE OF CONTRACTOR Or Subcontractor or Canceyation of Permit Change of Contractor is to be completed by the property owner,and the new contractor of record for the current permit. A new permit application must also be completed with new contractor information, signature, and transfer fee. A new Notice of Commencement must be filed in the new contractor's name for job values greater than $2,500 ($7,500 if AIC Change-out). A recorded copy must be submitted prior to commencing any work. Subcontractor changes can be completed by the general contractor. Absent extenuating circumstances, a.cancellation of permit is to be executed by both the owner and qualifier of record. Date: 01/2012016 Permit Number: SLC 1512-0465 Site Address: 6105 Raintree Trail Jensen Beach Plumbing State License FL#RF11067372 SLC License 246 Original General Contractor(or Subcontractor) State License SLC License New General Contractor(or Subcontractor) Reason for Change Customer went with another contractor The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers, agents,and employees from all costs, fees, or damages arising from any and all claims of action for any reason, which may arise as a result of this change of contractor/subcontractor or cancellation of Zet A permit cannot be cancelled if work has been perfor TU ER (or owner/builder) *SIGNATURE OF GENERAL CONTRACTOR PRINT NP14F La n it i.`r �' , �t�°t`iC� PRINT NAME L cYl rlL _e- State of Florida,County of St.Lucie County State ofPlorida,County of St.Lucie County The following instrument was acknowledged before me this The following instrument was acknowledged before me this 'L(> day ofyy 3 Cg1' .20�,by _ day of ,�Ci�,20 - by Lc"1i aA P::�1kl,P1G'1ecyC who is personally knowto me who is personally know tome or w has p oduced as ID. or who has produced as 71). atureo . ota ;•'a^�'~ tC JACLYN F WILSON ry alfa igoatareofNotary * N � MY CC)%IvISSiON#FF159rJ77 erA° a�AC-' YN F WILSON Only signatu e,_,Yec •zEnP NAYM"@"fbi A contractor rc. MY(:^.:aq,i�. N#FF159777 L U:53 FlaridayotorySeNice:..om '=yt.0 'a�• a -, �c�: [Xi!r1E3 Nr:vnrr:hnr 8.2016 Revised 0./21!14 • (d07)a93�f;,3 .zt.com Jan 201610:44a Jensen Beach Plumbing 772-225-6779 p.2 1 fl !o a UNIT 1086 NE Industrial Blvd, Jensen Beach, FL 34957 Phone (772) 225-6600 • Fax (772) 225-6779 License#RF11067372 St Lucie County Building Permit Office 01/20/2016 Hello, Sorry for the inconvenience, but I need to cancel a permit SLC-1512-0465 due to the customer decided to go with another contractor. 1 am requesting that we get a refund and can you please email me the refund amount. Email address renee-jbalumbing@bellsolith.net Thank you for your time, Renee Fuson