HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Oct. 20,2016 Permit Number: r Q
Building Permit Application NOV 0 C2016
Planning and Development Services
PERMITTING
Building and Code Regulation Division St.Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential xx
PERMIT APPLICATION FOR: Plumbing
PROPOSED, IMPROVEMENT,LOCATION:.
Address: 5408 Silver Oak Drive, Fort Pierce, FL 34982
Legal Description: Indian River Estates Unit 06-BLK 23 Lots 5,6, &7
Property Tax ID#: 3402-607-0274-000-7 Lot No.5,6,7
Site Plan Name: Block No. 23
Project Name: Water Hook up
Setbacks Front b� Back: ®® Right Side: Left Side:
DETAILED DESCR1N
IPTION OF ORK
CONSTRUCTIO:N'NFORMATION:
Additional work to be erformed under this—permit–c ec all t=appy:
❑HVAC —Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
11 Electric Plumbing Sprinklers ❑Generator
Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ �51� Utilities Sewer OSeptic Building Height:
OWNER/LESSEE' CONTRACTOR:
Name Mark&Lisa Tomko Name: 0WY\24Q_
Address:5408 Silver Oak Drive Company:
City: Fort Pierce State:FL Address:
Zip Code: 34982 Fax: City: State:
Phone No.772-519-2064 Zip Code: Fax:
E-Mail:mltomko6@gmaii.com Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION•
DESIGNER/ENGINEER: XX Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: Wells Fargo
Address: Address: 952OSouth us,
City: State: City: Fort Pierce State: FL
Zip: Phone: Zip: 34952 Phone: 772467-2250
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: XX 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.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S—1 - l.-l)C( 9--., COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this jj' day of 20 J)6' by this day of 20 by
L-i S� to rin KD
(Name of person acknowledging) (Name of person acknowledging)
(Signatu of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
SI,.��Lis UC c�JS
Commission No. S XA9 6 (Seal) Commission No. (Seal)
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. Revised 07/15/2014 NO T Aq�:�•o
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REVIEWS FRONT Z06SING SON M-ANS VEGETATION SEA TURTLE MANGROVE
COUNTER RE\SW. N FRL9V*y FLVIEW REVIEW REVIEW REVIEW
DATE 'i 9 •'• C/BLIG Q
COMPLETE
INITIALS