HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3/21/2016 Permit Number: 1p0,,3- CY-f6�
Building Permit Application
Planning and Development Services \ 0.
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: Plumbing
PROPOSED IMPROVEMENT LOCATION:
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Legal Description: , ,0464W,g ��u ,t.� Go a�+o n1 �r t u r -� Unrl T Q 7 -V-C,
AV C o rt.ti� c .v zGr�t,c,�Tf ^o ,e `j (,S 7 ' `3/-i
Property Tax ID#: 3(9// " S I? r O O y " O 0 O ` 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
FDETAILED DESCRIPTION OF WORK:
Move water shut off valve in front entry closet to be more easily accessible.
Move water lines in master shower to other side of shower.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check a appy:
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L_;HV^C Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric ❑✓ Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ � 1000 Utilities:n Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Daniel Ray Hokeness Name: D ALLG A&I M o 1,-,o
Address:10600 South Ocean drive#607 Company: Fo re• ///d, Pc cr OK RZIV&
City: Jensen Beach State:FL Address: Q.0 P oK 13 Ss
Zip Code: 34957 Fax: City: —I✓S / cam State:f L
Phone No.612-281-3420 Zip Code: 3 YRS-7 Fax:
E-Mail:drhokeness@gmail.com Phone No. -1_72-- 3 y2 - (9(0?'7
Fill in fee simple Title Holder on next page(if different E-Mail: rarz Niru Pi-WID-6 L wG. lel 1400
from the Owner listed above) State or County License: CF C /6/2- S�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 anney before
coMencing work or reco;:ding,your Notice of Commencement.
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L5igilature of Owner/'Le'ssee/Agent Signature o Contractor i e Holder
STATE OF FLORIDA N STATE OF FLORIDA
COUNTY OF st Lude w�N� COUNTY OF
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it'
The fo going instrument was acknowledged befor o o- The forgoing instru ent wasacknowledgedbefore me
this day of 20 Eby `°v this day of �{rliV ,20 by
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Dw io�_ 6�" 11n L�L/9 F ��
(Name of person ac k wledging) `�:�o,, (Name of person acknowledging)
( ignature of ary Pu lic-State of Flo da V (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identifip ti Personally Known V/ OR Prod d Identification
Type of Identification Producedf � �� Type of Identification Produced E.. . IA S
Commission No. (Seal) Commission No. ��I 1�0� 56%
COMMION x FF 160
o. PIRES Jarxwry IS. Q
•��u':� 5J FtatManom Sanloc.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS