HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/05/2017 Permit Number:
• Building Permit Application
Planning and Development Services
Building and Code Regulation Division
5300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential J
PERMIT APPLICATION FOR: Plumbing
'PROPOSEDIMPROVEMENTLOCATION:
Address: 4200 N HIGHWAY A1A APT 1009- FORT PIERCE, FL 34949-8337
Legal Description: OCEAN HARBOR SOUTH BLDG B UNIT 1009 AND UND INTEREST IN COMMON ELEMENTS (OR 1365-859).
Property Tax ID #: 1423-501-0169-000-2 Lot No.
Site Plan Name: Block No.
Project Name: WATER HEATER TANK REPLACEMENT
Setbacks F,ont Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALL A 30 GALLON [LOW BOY] ELECTRIC WATER HEATER TANK [OWNER -SUPPLIED]
UNDER A/C INSIDE INTERIOR HALL CLOSET.
CONSTRUCTION INFORMATION: 1
-Adlldd�itiona wdr to e erorme under tis permit - c check all h appy:
II0�IHVAC -Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
L_IElectric ❑✓_Plumbing ❑Sprinklers 11 Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction:$ 1000.00 Utilities: []Sewer❑Septic Building Height:
Name David A. Lauver B Pamela A. Lauver Name: Robert W. Ludlum
Address: 4200 N HIGHWAY AIA APT 1009 Company: BENJAMIN FRANKLIN PLUMBING
City: FORT PIERCE State: FL Address: 1631 SW SOUTH MACEDO BLVD
Zip Code: 34949 Fax: N/A City: PORT ST LUCIE State: FL
Phone No. 561-835-8308 Zip Code: 34984 Fax: 772-871-9069
E -Mall: N/A Phone No. 772-871-9494
Fill in fee simple Title Holder on next page ( if different E -Mail: permits@benfranklinplumber.com
from the Owner listed above) State or County License: FL #CFC1426801/SLC #23584
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
4
DESIGNER/ENGI NEER:
Name: oz d A. L.—I a Femele A. L.—
_ Not Applicable
MORTGAGE COMPANY:
Name: Ruoen w wdl—
_ Not Applicable
Address:L2WNHIGHWAY AIAAPT1008-FORT
PIERCE, FL 3484&6337
Address: 4200NHIGHWAYAMAPTID08
The far oing instrunna t as acknowled ep before me
this day / o[,' by
City: FORTPIERCE
Zip: Phone
State:_
City: PORTSTLUCIE
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address: 16313W SOUTH MCEDO aLVID
Address:
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City:
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City:
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Zip: Phone:
Commission No. �ieali
Zip: Phone:
FRONT
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 antl 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 attoor fore
commencing work or recordina gur Notice of Commencement.
Rev. 8/2/17
4
ature of Owner ssee Contractor as Agent for Owner
Signature of Contractor/L ense Ho d'�er///,,r/%
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The fo g instruo�nf�'as acknowledged before me
this by
The far oing instrunna t as acknowled ep before me
this day / o[,' by
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Name of perso making statement
Personally Known V OR Produced Identification
Name of persD aking statement
Personally Known VOR Produced Identification _
Type of Identification
Type of Identification
Produced
Produced
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1 IRES January 2G, 2021
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Commission No. (Seal)
Commission No. �ieali
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17