HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Jan_ 05, 2018 Permit Number:
J L01.
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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: Aqua RA Dr. Jensen Beach
Legal Description: Windmill Village by the Sea
Property Tax ID #: 4511-811-0002-020-1
Site Plan Name:
Project Name: —
Setbacks Front
Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace 40 gallon electric water heater (like for like)
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit — check a appy:
HVAC Gas Tank []Gas Piping_ Shutters � Windows/Doors
1-1 Electric RIPlumbing Sprinklers E Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 900.00
Sq. Ft. of First Floor: _
Utilities: F]Sewe r 11 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Robert & Joyce Long
Name: Gary W. Zanello
Address: 23220 Masonic Bv.
Company: Port St Lucie Plumbing
City: St. Clair state: Ml
Zip Code: 48082 Fax:
Phone No. 686 296-0016
Address: 6907 Heritage Dr.
City: Port St Lucie State: FI
Zip Code: 34952 Fax: 772 489-9126
Phone No. 772468-6524
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: portstlucieplumbing@gmail.com
State or County License: CFC058025
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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, l 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.
Rev. 8/2/17
Sign, tare of OWner/ Lessee/Contractor as Agent for Owner
SignatG�f Con or/License Halder
FLORIDA
STATE OF
STATE OF FLORIDA
COUNTY OFA--
COUNTY OFA
Theforgoing instru ent was acknowledged before me
"r
The forgoing instrument was acknowledged before me
thisday of %Z& zp [f3 by
this day of Jail ZQ 18 by
Gary W_ Zanelb
Gary W. Zanene
Name of person making statement
Name of person making statement
Personally Known X OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
4�9L�A -., Danielle 13iglin
4axi(i&
-1
(Signature of Notary P a i`_Fiori&94MISSION IFK01099
1
(Signature of Notary Pu f Florida
EXPIRES: August 25.2419
FF9014099 �i� ��` RONMTAAy.CoM
Commission No. � ;?��'�:d� �1{!�i#�M
? -_ CpMMISSION trF901M
FF901099y � Ap: gust 25, 2019
Commission No. '
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�R�R NOTARY.Eo�t
�11pL \*A�•
IlfJIM
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17