HomeMy WebLinkAboutBuilding Permit Application Jan 271610:06a First Choice Plumbing 7728797860 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 PermitNumber: 1-d3�3
oil - AN! RECE-11-'0 JAN 2 7 2016
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 _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
W r� 1
Legal Description: OC-
Property Tax ID#: 3326-10 100OR-0-M-0 _ Lot No._�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Bight Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
rtiona war to be ertormed under this permit-check alftflat appy:
HVAC L_J Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric W—Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$_��Lf o Utilities: Sewer ElSeptic Building Height:
OWN ERAESSEE: CONTRACTOR:
Name 1pc-G& Name MJP-1 C
Address:ld\,aSM :Cd\)ekJN 1E6 WO•y Company: kc �b
City: 4s�r l '&.h 1.G State: Address: C
Zip Code:NS%LD Fax: City:20r - S&_ L.iele. Stater
Phone No"M Zip Code:sB'1q%V Fax g�-7$(00
a
E-Mail: Phone No.77,2-71")- Ii4 k
Fill in fee simple Title Holder on next page(if different E-Mail: tiff.
from the Owner listed above) State or County License-, l�'11�3�� C
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Jan 271610:06a First Choice Plumbing 7728797860 p.3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERJENGINEER: ,Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLETITLE 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 roperty.A Notice of Commencement mu be recorded and posted on the jobsite
before t first inspe ion. If you intend to obtain financing,con with lender or an attorney before
comm d rk o recordin our Notice of Commencem
yoL
/) -� s
Si nature of Owner Lessee/Agent ignatu a of Contractor/Li ense Bolder
ST TE OF FLORI A ("_f, �� STAT OF FLORIDA
CO NTY OF c3 COU OF
Th for oing instru entwas acknowled ed before me The orgppg instrument was acknowledged before me
th s, ay of N 0 /6by th' �Ylld1ay of .;;R1V (#15 20 �by
(Name of person acknowledging) (Name of person acknowledging)
{Signature of N4ary Public-State of F rida) (Signature of Nota Pub'c-State of Florida)/
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification roduced Oo tification Prcduc .,
Commission No 3 ,�- L I;IV ?;S;;tG! i� No. EO- �dt{ r h4WMISS10N#EEB30
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(407)396"0163 F.nridallotmvSu ice.com i4p7)336 4153 FloridallotaryScw(ca.eom
Revised 07/1512014
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INITIALS