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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 0s_1 (4, • Permit Number: J k-1-01 I RECEIVED s Ism Building Permit Application JAN 13 2016 Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential Xxxxxxxx PERMIT APPLICATION FOR: Plumbing: PROPOSED IMPROVEMENT LOCATION: Address: 9801 S Ocean Drive(PROJECT)Jensen Beach,FL 34957 Legal Description: Property Tax ID#: 4502-501-00000000 Lot No. Site Plan Name: Nettles Island Inc Block No, Project Name: Nettles lSland Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: drain & remove existing LP gas 50 gallon water heater and need to go back to reinstall for bath house 10 CONSTRUCTION INFORMATION: Additional wor toOGasTank Orme under this permit—check a appy: HVAC FGas Piping 1:1_Shutters a Windows/Doors Electric 0 Plumbing Sprinklers E Generator 11 Roof Total Sq. Ft of Construction: JS Ft.of First Floor: Cost of Construction:$ t!! Q©' Q D Utilities:ll Sewer 0 Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Nettles Island Inc Name: Lonnie Culbertson Address:9801 S Ocean Drive(PROJECT) Company: Jensen Beach Plumbing City Jensen Beach State:FL Address: 110086 NE Industrial Blvd Zip Code: 34957 Fax: City: Jensen Beach State:FL Phone No.772-229-5417 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-jbpiumbing@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. dv !_SY Z'd 6LL9-9ZZ-ZLL 6ulgwnld y0e88 uesuar d 6Z:l,0.9 l, 0l•Uef 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 certifythat 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 ar 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. w 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 commendrilz work or recorgLng your Notice of Commencement. lgnature of Owner/lessee/Agent '"nature of Contr6-ffr_lLi ense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF- n-N oLfc rn COUNTY OF YY1c,F2-kyi The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 4'3 day of 21 a.nic v-z.1 20 t t_by this 13 day of 3nrx tttA, 20 ti by (Name cf person acknowledging) (Name of person acknowledging) nature 6INotary Public-State of Florida I (Sig& re of NcyryPublic-State of Florida I Personally Known 1POR Produced Identification Personally Known I/` DR Produced Identification Type of Identification Produced Type of Identification Produced Commission No. �>i iS�Z r,;�yp ea I ission No. r` f= S`-J__Q oto "`e� (SJAI�LYN F WILSO �< JACLYN F WILSON ' ' MY COMMISSION#FF159 i My COMMISSI EXPIRES November 8,2018 (4p7)398-0153 FlorldallotaryServicex= Revised 07/15/2414 (407)3WO153 FluidallolaryService.com REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS • 0'd 6LL9-9ZZ-7,LL bulgwnld yoeeEl uasuar d6Z:6O9L£6 Uer