HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 �1
Date: O �j Permit Number: \
AUG 24 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 X
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 180 BANYAN DRIVE PORT ST LUCIE, FL 34952
Legal Description: RIVER PARK UNIT 3-TRACT E BLK 135 LOT 10(MAP 34/22S) (OR 1120-1950 THRU 1156
Property Tax ID#: 3419-52-0011-000-2 Lot No. 10
Site Plan Name: Block No. 135
Project Name: CHRISTENSEN
Setbacks Front Back: Right Side: Left Side:
DETAILED DESC�RIPTION�OF,WORK u�' ���
�, ..
REPLACEMENT OF 50 GALLON NATURAL GAS HEATER WITH SAME
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit—check all appy:
rn
HVAC Gas Tank0Gas Piping _Shutters Windows/Doors
Electric ZPlumbing Sprinklers Il Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1,850.00 Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR: �
Name KIMBERLY CHRISTENSEN Name: RICHARD BASSOFF
Address:312 CENTER HILL ROAD Company: ADMIRAL PLUMBING SERVICES, LLC
City: PLEASANT VALLEY State:_ Address: 2895 JUPITER PARK DRIVE#700
Zip Code: 06063 Fax: City: JUPITER State.FL
Phone No.860-250-7055 Zip Code: 33458 Fax: 561-744-7101
E-Mail: Phone No. 561 746-1180
Fill in fee simple Title Holder on next page(if different E-Mail: THEADMIRALPLUMBERQGMAIL.COM
from the Owner listed above) State or County License: CFC 1426115
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:
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
commej44png work or recording our oticp of Commencement.
s
Si'94tufre of Owner/Less /Agen Signahtrpd gKntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z.Zday of 20 Irby this ZZday of — 20 It, by
cle
(Name of person acknowledging) (Name of person acknowledging)
LL
(Signature of-Notary Public-State of Florida) —( igr; ture of otaryPublic-State of Florida)
Personally Known—OR Produced Identification Personally Known_)( OR Produced Identification
Type of Identification Pr Type of Identificatio Pod ced
Notary Public State of Florida gg Notary Public a�{Florida
Commission No. . Lori C(£ k)ell Commission No. ri Campba'J
My Commission EE 854768y� My Commission EE 854768
ovn Expires 11/29/2016 pro o Expires 11/29/2016
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS