HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: k V-6 Permit Number: Al O1-oa57
RECEI%'r:-D JAN) 13 7017
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: To Select from dropbox, click arrow at the end of line k'A
PROPOSED I*R-'OVEMENTFLOCATION .
Address: 5804 Birch Drive, Fort Pierce FL. 34982
Legal Description: INDIAN RIVER ESTATES-UNIT 08-BLK 63 LOTS 14 AND 15 (MAP 34/11 S)(OR 3417-794)
Property Tax ID#: 3402-609-0412-000-3 Lot No.14&15
Site Plan Name:'INDIAN RIVER ESTATES Block No. 63
Project Name: INDIAN RIVER ESTATES
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF,`WORK a
Re-pipe water lines in entire house. piping will be CPVC and or PEX
CONSTRUCTION`INFORM4TI0N
,
Additional work toeperformed. under this permit—check a that appy:
HVAC Gas Tank []Gas Piping Shutters ❑Windows/Doors
11 Electric 10 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 2,400.00 Utilities: Sewer Septic Building Height:
01NNER/LESSEE CONTRACTOR
Name Dr, c <1,e- ,,S.f,1, /" Name: Paul Shaughnessy
Address: 4'98'U1-1 �l-O/ /'41 Company: United Plumbing Solutions LLC.
City: )':f_ i -, , B State:_� Address: P.O. Box 1827
Zip Code: 39.9irz Fax: City: Palm City State:FL
Phone No. ?�I— 9e2 —df71 6 Zip Code: 34991 Fax: 772-679-0212
E-Mail:. Phone No. 772-240-8468
Fill in fee simple Title Holder on next page(if different E-Mail: pauis@ups-plumbing.com
from the Owner listed above) State or County License: CFC1426338
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU PLEI1/iENT LeCON$TR'UCTIC?N LIEN LAVI/ INFORMATION s x
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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 thepermit 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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Signature of Owner see ontractor as Agent for Owner Signature o Contrac License er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 k- d-J 1 COUNTY OF 3* . L 'k
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this k3 day of 5a,r, 20 Al-by thisN day of�d►� 20 Q—by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P Iic-State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR P �IE1 —; Personally Kn
Type of Identification P 1% AI-I isr,Go22023 i Type of Iden i l.'.. der EMS
W Comm"'...- ier 16 2020 ) w P e 02202,3
Commission No. �� ....ia I�M=publlcUnd,W11-3n. ` Commission o'. •�` E3:December I
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NotaryPublk`ilnr ery�;,,• I
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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