HomeMy WebLinkAboutBuilding Permit Application f
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ' 1 _
Date: Permit Num ber: ! ! ' �IJIU
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Building Permit A licati in
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of fine
PROPOSED IMPROVEMENT-.L-OCATION
Address: 5920 SPRING LAKE TERR. ,
Legal Description: PORTOFINO SHORES-PHASE THREE-(PB43-40) LOT 387 (ORRj2351-1537)
Property Tax ID#: 1312-503-0160-000-4 i t' Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Sidef
DETAILED DESCRIPTION:.OF-WORK
REPLACE 50 GALLON ELECTRIC WATER HEATER IN GARAGE
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CO'NSTR_UCTION INFORMATION
.Additionalwor to e e orme ''
under this permit—check all that appy:
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HVAC _Gas Tank ❑Gas Piping Shutters LLJ Windows/Doors
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Electric 0 Plumbing []Sprinklers E]Generator Elilo& Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ 800.00 Utilities:0Sewer Septic j, Building Height:
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OWNER/LESSEE _ NT AC, �I'k
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NameBECKELTON CHANTILOUPE Name: GARY FERRIS
Address:5920 SPRING LAKE TERR Company: REEL PLUMBING
City: FORT PIERCE State:FL Address: 4715 S US HIGHWAY;1
Zip Code: 34951 Fax: City: FORT PIERCE I State.
Phone No.772-224-1843 Zip Code: 34982 i Fax:
E-Mail: Phone No. 772-621-8282;
Fill in fee simple Title Holder on next page(if different E-Mail: REELPLUMBINC it HOTMAIL.COM
from the Owner listed above) State or County License: CFC-1429318
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN.-LAW INFORMATION--
DESIGN ERANG IN EER:
NFORMATION DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:';,, _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: hone:;
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: I` '_Not Applicable
Name: Name:
Address: Address: I i
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do ttie-work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
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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 Iny 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 fir ' spection. If you intend to obtain financing, consult with fender or an attorney before
commentork or recordWR yourrecord' Notice of Commencement. X�
5 nature of O ner/L �
see/Contractor as Agent for Owner Signat re of Contrac ns
/Licee Holder
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STATE OF LORIDA STATE OF FLORIDA
COUNTY OF .I�,�-,�, COUNTY OF I
The forgoing instrument was acknowledged before me The fqr oing instrument was!acknowledged before me
this day of ItA.1 ,20Z by this I day of IW6✓ .20j3 by
Name o person making statement Name ctp4son making statement
Personally Known OR Produced Identification Personally Known OR'Produced Identification
Type of Identification Type of Identification
Produ ed
Produced
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Uh—
gn ure of Notary Public-Atate of Florida) (Signature o otary Pu lic-State of lorida)
Commission No. Q,, ,,,� L ?4}iNA INGRAM Commission Nod �3� (Seal)
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2 Notary Public state of Florida 2o....Y" a,,,, LASHAHNA INGRAM
My Comm.Expires Dec 20,2018 ;'`,� �¢oa LPdotary Public-State of Flori
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c, r,l,l .� � s";` . oP: � � 20,2018
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REVIEWS FR, y,r -,ZQ Ml - SUPERVISOR PLANS VEGE A'1dON els "zfl�kT',t MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW "''v''' "REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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