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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO B�ACCEPTED I /�
Date: 12/22/15 Permit Number:
•
Building Permit Application
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 8240 Sandpine Circle
Legal Description: Lake Lucie Estates, plat number one, Lot 11 (OR1453-749)
Property Tax ID#: 3426-703-0025-000/6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Installed 40 gallon gas water heater.
CONSTRUCTION INFORMATION:
Additional work toe nerformed under this permit—c ec a appy:
HVAC Gas Tank Gas Piping _Shutters Windows Doors
11 Electric 0 Plumbing Sprinklers ❑Generator F] Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Kellie Young Name: Dale Hammond
Address: 349 Superior Rd Company: For Him Plumbing
City: Egg Harbor Twp State: NJ Address: P 0 Box 1355
Zip Code: 08234 Fax: City: Jensen Beach State:FL
Phone No. 772-528-5579 Zip Code: 34957 Fax:—
E-Mail: 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: CFC 1428915
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
M.1r a
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: XX Not Applicable MORTGAGE COMPANY: XX Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: XX 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
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF9-(JLd 1 Tj n COUNTY OF l`'l
The r ping instrument was acknowledged before me The fo�oing instrument was acknowledged before me
this day of^�� 20Ofiby this'^day of - 20 1,Lf by
(Name of person acknowledging) (Name of person acknowledging)
(Sign tur of Notary Public-State of Florida) (Signature of Wtary Public-State of Florida)
Personally Known OR Pro ed Identification Personally Known OR Produced I ntification
Type of Identification Produced `' tel, Type of Identification Produced
Commission No.�-c (Seal) Commission No.\�t 1 (Seal)
MONIQUE M.CARLONI
otary Public,State of F1
Revised 07/15/2014kIk"t
MONIOUE M.CARLONI Commission#FF 182467
4. ". .m.expires Dec.10,2018
tary Public,State of FloridaComm 10 Ft-JUZ4bf
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