HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
4� J -- 4_
MAL
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: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 12445 SE HARBOUR RIDGE BLVD 3-8
Legal Description: POND APPLE VILLAGE UNIT 3-8 (OR 3796-802:3857-2891)
Property Tax ID#: 4425-620-0024-000-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace 50 gallon existing electric water heater
CONSTRUCTION INFORMATION:
Additional work to a er orme under this permit—check a app y:
11HVAC E]GasTank ❑Gas Piping Shutters Q Windows/Doors
11 Electric 0 Plumbing O Sprinklers E_Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 700.00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Mildred Mariner Name:
Address:12445 SE HARBOUR RIDGE BLVD 3-8 Company: Mr Rooter of the Treasure Coast
City: Port St Lucie State:Fl Address: 534 NW Mercantile Place, 119
Zip Code: 34984 Fax: City: Port St Lucie State:fl
Phone No.(917)696-6492 Zip Code: 34986 Fax:
E-Mail: Phone No. (772)236-7300
Fill in fee simple Title Holder on next page(if different E-Mail: James.mrrooter@gmail,com
from the Owner listed above) State or County License: CFC1425604
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:Mildred Mariner
Name:
Address:12445 SE HARBOUR RIDGE BLVD 3-8 Address: 12445 SE HARBOUR RIDGE BLVD 3-8
City: Port St Lucie State: City: Port St Lucie State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:534 NW Mercantile Place,119 Address:
City: City:
Zip: Phone: Zip: Phone:
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 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
com encin rk or recording our Notice of Commencement.
nature of caner/Lessee/Contractor as Agent for Owner Sign ure of Con ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S� Ic,u:.e, COUNTY OF.e . - IuC,L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of"QecL-r.\,�.L& _ 20 by this-day of 20-1!7 by
_�cr�_%eS S orlct 1 r
Name of person making staterner t Name of person r�7aking statement
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Signature of Notary Public-S t��� a ) KRISTENL BENSLE S g ature of Notary P ic-S te, „P,I rida ) KRISTEN L BENSLEY
Notary Public•State of lorida
ommission No.F.1r al)Commission#►,FF 970 �o ission No.F� * +' Sept�(y Public•State of NO,
occh.• °� r, Lbtnmi.ssion#r FF 9704 5
My Comm.Expires Mar 1 ,2020
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17