HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/13/2016 Permit Number:
e a d1' i iT r•-__.
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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 Commercial Residential J
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: -_.• .,., — fi`
Address: 5111 BIRCH DR - FORT PIERCE, FL 34982
Legal Description: 3402-608-0377-000-2
Property Tax lD a: INDIAN RIVER ESTATES-UNIT07- BLK50 LOT 29 (MAP 3UO2S)(OR 696-1967822-2579'1214-2257,3914-1953). Lot NO. 29
Site Plan Name: Block No. 50
Project Name: WHOLE HOUSE SUPPLY RE -PIPE - PLUMBING - RESIDENTIAL
Setbacks Front Back: Right Side Left Side:
I DETAILED DESCRIPTION OF WORK:
PERFORM WHOLE HOUSE [ALL HOT/COLD WATER SUPPLY LINES] RE -PIPE; INCLUDES 1/4
TURN BRASS BALL VALVE AT MAIN WATER SERVICE FEED
CONSTRUCTION INFORMATION:
AD o itional wo rk to be
❑_HVAC
errormed a ntler
Gas Tank
th is perm it — check all
EGas Piping
apply:
_Shutters
Windows/Doors
11 ❑✓_Plumbing
IJ
0Roof
F
Electric
Sprinklers
Generator
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:$ 8326.00
SFt. of First Floor:
Utilities:cn Sewer D Septic Building Height:
OWNER/LESSEE: • -
Name William L. BAILEY
Address: 5111 BIRCH DR
City: Fort Pierce State: FL
Zip Code: 34985 Fax: n/a
Phone No. 772-971-9208
E -Mail: n/a
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:.
Name: Robert W. LUDLUM
Company: Benjamin Franklin Plumbing
Address: 1631 SW South Macedo Blvd
City: Port St Lucie State: FL
Zip Code: 34984 Fax: 772-871-9069
Phone No. 772-871-9494
E -Mail: permitsi@benfranklinplumber com
State or County License: CFC1426801
if value of construction is $2500 or more, a RECORDED Notice of ammencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not Applicable
Name:
Address:
City:
State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
State:
Not Applicable
St. Lucie Count% makes no representation that is granting a permit will authorize the aermit 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' spection. If you int d to obtain financing, consult with lender o9ef before
'rpmm_eH ;r recordi g v otice of Comme icemen.
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� Signature ofOwner/ Lessee/Agent Signtrfure o Lontractor Licens
STATE OF FLORIDA
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Theorgo'ng instrum�entp ackow
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this day�of QJc/ �✓%��. 2" by
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(Name of person ac noing)
(Signature of Notary
Type of Iden
Commission
Revised 07/15/2014
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STATE OF FLORIDA
COUNTYOF �&G�e
The forgoing instrument was acknowledged before me
this � day of /%ZV&P/ . 2016 by
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peron
(Nameo sacknowledging)
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ignature of Notary Public -State of Flori a )
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pe of Identification Pro paY-NFF+e5Tl2
mmissian EXPIRE Cotober 1, 2018
REVIEWS FRONT ZONING SUPERVISORPLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS