HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO��MUST>BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / ` otc / (0 Permit Number: / o o 1, Q3S? `
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Building Permit Application JAS 2 6 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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Q7MWMMPROVEIVIENT LOCATION;
Address: 8801 One Putt Place /� �p
Legal Description o ,-o e `�{� V
Property Tax ID#: �'/ ' lJ�' liV I Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTI®N OF UVORK:
Replace water heater 50 gal elec
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CC.,NSI'RUCTI`ONINFORMATION
Additional work toa er orme under this permit—check a appy:
HVAC 11 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 795 Utilities: Sewer Septic Building Height:
®WNER/LESSEE: CONTRACTOR: u
Name e-ir Name: Anthony Agrusa
Address:8801 One Putt Place Company: North County Plumbing
City: Ft. Pierce State: Fl Address: 2647 Old Dixie Highway
Zip Code: 34986 Fax: City: Riviera Beach State:FI
Phone No.772-465-1497 Zip Code: 33404 Fax: 561-625-8717
E-Mail: Phone No. 561-625-9414
Fill in fee simple Title Holder on next page(if different E-Mail: Northcountyplumbing@hotmail.com
from the Owner listed above) State or County License: CFCO26530
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S�.tPPLEI�IEN LCONSI'R.UCTI®N L,EN LP►U1l INF®RMA1TION.
DESIGNER ENGINEER: _Not Applicable pp 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 r an attorney before
commencing work or recording our Notice of Commencement.
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Si ature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA ^ ' � /� STATE OF FLOR,
COUNTY OF l�(� if'J COUNTY OFA
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Theing instrument was acknowledged before me The f rgoing instrument was acknowledged before me
thisr oday ofS 20�kby this a5ofdday 20 16 by
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(Name of person acknowledging) (Name of perso knowle i gW I A
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(Signature of Notary Pub is tate of Florida) Aatu—i e of Notary Public- a of Florida)
Personally Known §QLAic.ti Personally Known1w;Z
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Type of Identificatio Pr,dtjas P ype of Identifica
?*•�b4� Notary=Public-State of Florida NotaryFOR tate of-FTorra'a>
Commission No. = •'= a6ieeiG�sion#FF 197676 Commission No. #-FF 197676
oP, ,•��FOFF�°:���c pAy Com . xx ares Apr 20,2019
••,���o1f, My Comm.Expires Apr 20,2019
Bondedt �'0 Bonded through National Notary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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