HomeMy WebLinkAboutapplication Jul 0616 01:33p CRS Plumbing 772-460-7774 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number. ftoff)
Building Permit Application
Planning and Development Services
Building and Cade Regubtion D!vWon
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-ISS3 Fax:(772)462-1S78 Commercial Residential xxxx
PERMIT APPLICATION FOR: Plumbing
-PROPOSED IMPROVEMENT LOCATION:
Address: 6231 Arlington Way
Legal Description: PORTOFINO SHORES-PRASE TWO-(PB 43-33)LOT 179(OR 20784780;2338-1735.2454-1262;2567-1947)
Property Tax ID#: 13112-502-0080-00" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace exisOnWgal electric MH
#0
CONSTRUCTION INFORMATION:
Additional worKt0Dg_perTdrmed under this permit—check all t=a
13HVAC Li Gas Tank [:]Gas Piping Shutters F]Windows/Doors
1:1 Electric 1J Plumbing E]Sprinklers Generator Floof
Total Sq.Ft of Construction: Scl.Ft.of First Floor:
Cost of Construction:S 800-00 Utilities:0Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Alicia S Khan-Amar Name: Reed Sudderth
Address-2472 Poinciana Ln Company: CRS Plumbing
City. WestonState:FL Address: P.C.Box 12755
Zip Code: 33327 Fax. City: Fort Pierce State:FL
Phone No.954-384-0&36 Zip Code: 34979 Fax: 772-460-7774
E-Mail: Phone No. 772-466-7763
Fill in fee simple Title Holder on next page if different E-Mail: crspiumbing@beflsouth.net
from the Owner listed above) State or County License: CFC14263853
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
CAX'E) 7-7- /4
Jul 06 16 11:31 a CRS Plumbing 772-460-7774 p.3
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 TITLEHOLDER: —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.
5t 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.
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Si re of Owner/Lessee/Agent Signat of Cont ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF s, w COUNTY OF s��„�
The fo oIng instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of JUL 20 Lby this G day of Jy'�' 20 16 .by
Edward D.Jan&&#- Edward D.Jendan
(Name of person acknowledging) (Name of person acknowledging)
�9, S'
(Sig ture of Notary Public- to of Florida) (S nature of Notary Public-01te of Florida)
Personal &�ce on' Person iy R Ir- t :ation
Type of 1 $tit. cam' Type of itr�51{- Gt�d'
+s MY COMMISU `'�, �' MY COMM199 124587
Commissi n�@�r-i. EXPIRES Mey 1!W a Commi i °`' EXPIRES May 19,2 �1
1471 39"IS3 #oridtl M i==M (407)3N-0153 F10rkXN01WVSetv1ce.cam
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS