HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/08/2017 Permit Number:
• 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 J
PERMIT APPLICATION FOR: Plumbing
PROPOSED INIPROVEMENTION:
Address: 4812 Hickory Dr - Fort Pierce, FL 34982
Legal Description: INDIAN RIVER ESTATES -UNIT 07- BLK 46 LOT 6 (MAP 34/02N) (OR 527-2058).
Property Tax ID #: 3402-608-0201-000-8 Lot No. 6
Site Plan Name: Block No. 46
Project Name: Water Heater Tank Replacement
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install a 50 gallon electric water heater tank in laundry room.
CONSTRUCTION INFORMATION:
Ado l��rtliona workto offormed Orme un ert is perm it —checka appy:
L®IHVAC Gas Tank ❑Gas Piping _Shutters L1 Windows/Doors
Electric ❑✓_Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: 5t �l�Ft. of First Floor:
Cost of Construction:$ 1800.00 Util[ties :l1 Sewer []Septic Building Height:
Name Nancy S. Gorniewict Name: RobertW. Ludlum
Address: 4812 Hickory Dr Company: Benjamin Franklin Plumbing
City: Fort Pierce State: FL Address: 1631 SW South Macedo Blvd
Zip Code: 34982 Fax: ale City: Port St. Lucie State: FL
Phone No. 772-466-9999 Zip Code: 34984 Fax: 772-871-9069
E -Mail: 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 CFC #1426801/SLC #23584
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
j° SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
L
WrTature of Contract
DESIGNER/ENGINEER: _Not
Name: Nana S. com
Applicable
MORTGAGE COMPANY:
Name: Roben w LudWm
Not Applicable
Address: 4912 Hickory DI -Fon Pie ,FL 36992
COUNTYOF )
Address.4912Hickwr Dr
The forgying instrylt!�ent was acknowledged before me
this dayo`fy,Qt'. 20_q by
City: Fon Piece
Zip: Phone
State:_
City: Poe sl.waa
Zip: Phone:
State:_
FEE SIMPLE TITLE HOLDER: _Not
Name:
Applicable
BONDING COMPANY:
Name:—
ame:Address:1631
_Not Applicable
Address: 1631eW SvAh Mawm Bixa
Produced Identification
Address:
Type of Identification
City:
Produced
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 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 attorney before
commencing work or recordiou vour Notice of Commencement_
igna re f ner/Lessee/Contractor as Agent for Owner
L
WrTature of Contract
se Holder
STATE OF FLORIDA ` j1 � L,,
COUNTYOF JLUZ1A w'-LV'I'
STATE OF FLORIDA CSC
COUNTYOF )
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The forgying instrylt!�ent was acknowledged before me
this dayo`fy,Qt'. 20_q by
The for oing instru ent was
this day of eF-
acknowledged before me
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Name of perso aking statement
Name of perso aking statement
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Personally Known OR
Produced Identification
Type of Id. ti oration
Type of Identification
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Produced
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Commission No. 15iI4 29.2021
Commission No.
02199
Sen 1}ry 91 2
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
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