HomeMy WebLinkAboutBuilding Permit Application 05/02/2016 9:53AM FAX 7726217882 ALL CITY PLUMBING Two fa0001/0003
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) (�
Date: .2 Permit Number: l oo COD?
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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 1 Commercial _ Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR'Oi?Q$ED;l Pf OVEMENT LOCATION..j
Address: 12096 Riverbend Road
Legal Description: Bay St Lucie Lot 14
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Property Tax ID#• 4422-502-0017-000.1 i ,I, Loi No.
Site Plan Name: Block No.
Project Name•
Setbacks FrontBack: Right Side:_._ Left Side:
DETAILED,D•�5CIIPTION OF WQRK
Install 54 Ga! Electric Water Heater
CONSTRUCTION.•IN...FO..I .MATION :: .:;;• . ::
Additionalwor to e e orme un ertinis permit—cheCK all apply:
HVAC Gas Tank ❑Gas PipingCGenerator
Shutters +� Windows/Doors
Electric Plumbing ❑Sprinklers Roof
Total Sq.Ft of Construction: ; S .Ft.of First Floor:
Cost of Construction:$ 900.00 Utilities: _Sewer L1eptic Building Height:
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:bW..' R/LESSEE:; CONTRACTOR:
Name Russet)Rockwell Name: Jason E.Parish I�
Address:12096 Riverbend Road Company:All City'•Plumbing Two, Inc,
City: Port Saint Lucie State:FL Address: PO Box 880641 I,,'
Zip Code: 34984 Fax: City: Port Saint Lucie State:FL
Phone No,772-631-3038 Zip Code: 34986 Fax: 772-621-7882
E-Mail: Phone No. 772-891-3038
Fill in fee simple Title Holder on next page(if different E-Mail: holly a@allcityplumbit gtwopshcom -
from the Owner listed above) ! State or County License: CFC1427492
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If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
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05/02/2016 9:53AM FAX 7726217882 ALL CITY PLUMBING TWO, 120002/0003
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SUP.PLEMENTAL?CONSTRUCTION'LIEN '�AW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY- x Not Applicable
Name: Name:
Address: Address: J
City: State City: 11 State:
Zip: Phone: Zip: Phone: !I
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FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: i�; x Not Applicable
Name: Name:
Address: Address,
City: City: 6
Zip: Phone: Zip: Phone,• I
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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-IL 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 Homeowners 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 exemptjfrom 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 0 Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded add posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencina work or recording our Notice of Commencement.
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sigrai6e of owner/Lessee gent i Signatu e f contractcir/ldlcev#Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF et i.uei9 i
The fors ing instrument was acknowledged before mer The forgoing instrument was acknowledged before me
this7Mday of 20 LlQby this day of Ma III' 20 ,�&by
J.-i Parish , iii Pafisri I,
(Name of person acknowledging) (Name of person acknowledging)
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( � nature of Nota Public-State of Florida) (Si ature of Notary P ic-State of Florida)
Personally Known x OR Produced Identification Personally Known x 1 OR Produced identification
Type of Identification Produced Twa,of Identification'Producedf'
SURM
Commission No. eEeaasse r A�' mission No, eeaa�a� L%%A
6i01V# g
EXpmq ocbiDar t6, EXPIi;elr6 October I&ZM
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ;� SEA TURTLE MANGROVE
COUNTER -REVIEW RE1 IEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS . l _
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