HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0a
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Building Permit Application RECEIVED
Planning and Development Services MAR 2 9 2016
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Plumbing
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Address: Regency Island Dunes II,8600 South Ocean Drive, Jensen Beach, FI 34957
Legal Description:
Property Tax ID#: 3534-"!5'V — 0000--6 Q 0. Q Lot No.
Site Plan Name: Regency Island Dunes II Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Replaced 50 gallon electric water heater Icoated in utility room servicing social room and public
restrooms.
itiona wor to e e orme un er t is permit—c ec a appy:
HVAC �Gas Tank ❑Gas Piping _Shutters �Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 930 utilities:)Sewer Septic Building Height:
Q1/UNERLESSE , � £j �� > CQNTRACTOR �
Name Condominium Association Name: Dale Hammond
Address:8640 South Ocean Dr Company: For Him Plumbing
City: Jensen Beach State:FL Address: P O Box 1355
Zip Code: 34957 Fax: City: Jensen Beach State:FI
Phone No.772-229-0311 Zip Code: 34957 Fax:
E-Mail:regency8640@aol.com 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: CFC1428915
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:
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.
2E/Z___0s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Ir LuiNf— COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this a, day of MQ r&h , 20 U�Jby thisza_day of N/l ar�cl� .20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known V OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Produced Identification Produced
r- " ;, MELANIE ED ARCS � r p :��%" �;= MELANIE EDW r.
Commission No. :! )MY COMMISSION tl It irattiti Sion No./'r LJ�1160
I)MY COMMISSION 5.
°,.. EXPIRES January,8.2020 EXPIRES January 7
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Revised 07/15/2014
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