HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: January 30,2018 Permit Number:
RECEIVED
Building Permit Application JAN 3 0 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
13.00 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County
Phone: (772)462-1553 Fax:,(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Plumbing
P,f by SE3D INiPROVEfVIENT LOCATIOiV 1{� h . T {r ." K
t
Address: 5710 CASSIA DR-FORT PIERCE, FL 34982
Legal,Description: INDIAN RIVER ESTATES-UNIT 09-BILK 80 LOTS 3 AND 4 (MAP-34/12N) (OR 3985-378).
Property Tax ID#. 3402-610=0294-000-3 Lot No.3'AND 4
Site Plan Name: Block No. 80
Project Name: WATER HEATER TANK REPLACEMENT
Setbacks Front Back: Right Side: Left Side:
7
DETAILED DESCRIPTION OF WORK
1.< .
t, d
INSTALL ELECTRIC WATER HEATER TANK IN GARAGE.
=C10�NSfI�UCTION INF4:,
Additional wor -o be,nertormedunder this-permit—check all appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors:
Electric ❑✓—Plumbing OSprinklers Generator F]Roof Roof pitch
Total Sq. Ft of Construction: Sq.Ft. of First Floor:
Cost of Construction:$ 225.00 Utilities: Ln�Sewer OSeptic Building Height:
OWNEaR/LESSEE f*Y µCONTRACTQR 4 `` ` {
Name Ronald and Michelle WENTZ Name: Robert W.LUDLUM
Address:5710 Cassia Dr Company: Benjamin Franklin Plumbing
City: Fort Pierce State:FL Address: 1631 SW South Macedo Blvd
Zip Code: 34982 Fax:n/a City: Port St Lucie State:FL
Phone No.772-871-9494 Zip Code: 34982 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: #CFC1426801 /#23584
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPIEMENTgL CONSTRUCTION LIEN LAW INFORMATION, ' '
'.7...
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:Ronald and Michelle WENTZ N am e:Robert W.LUDLUM
Address:5710 CASSIA DR-FORT PIERGE,FL'34982 Address: 5710 Cassia Dr
City:.Fort Pierce State: City: Port St Lucie State:
Zip: Phone Zip: Phone:
FEESIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:1631 SW South Macedo Blvd 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 tray 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 Cornmence'rhent must be recorded and posted on the jobsite
before the first inspection,if you intend to obtain financing;consya ith lend r an attorney before
commencingworkw recor ' ? our Notice of Commenceme .f
Y.Fnajure of OjWqerl Le ee/Contractor as Agent for Owner S g6ature ofcondeio'r7bcense Holder
STATE OF FLORIT / STATE OF FLORIDA
COUNTY OF C}7. (,� Il_{,(f�/�i COUNTY OF' ► 1'
The forgoing instrument was acknowledged before me The forgoing ins�t.j u,ment was acknowledg efore me
this 3U day of�Tj '� 20�by fhls % day df j F: } 20 by
Name of person making statement Name of person making statement
Personally Known lo/ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
f'
tl
"A
(Signature of otary P t (Signature of Notar *01.0e
a t(Signature#GG066499 COMM
ISSION#0GO66499
EXPI �I�anua28,2021 IEX?IRE$ � 26,2021 No. Commission No.
i
G
REVIEWS FRONT vZONING SUPERVISOR PLANS VEGETATION SEATURTLE 'MANGROVE
COUNTER ;REVIEW REVIEW REVIEW REVIEW REVIEW. REVIEW
DATE
RECEIVED
DATE
CONI PLETED E
Rev.8/2/17'
i