HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
-4 ,S
- _
•
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 102 AQUA RA DR JENSEN BEACH FLORIDA 34957
Legal Description: WINDMILL VILLAGE BY THE SEA
Property Tax ID #: 4511-811-0022-000-1
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side
DETAILED DESCRIPTION OF WORK:
REPLACE 50 GALLON ELECTRIC WATER HEATER IN SHED IN CARPORT
Left Side:
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit— check all appy:
HVAC Gas Tank 0Gas Piping Shutters Q Windows/Doors
Li
11
Electric Plumbing Sprinklers Generator F� Roof Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 800.00
S Ft. of First Floor:
Utilities: Sewer r] Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameHENRY T. NIELANDER
Name: GARY FERRIS
Address: 102 AQUA RA DR.
Company: REEL PLUMBING
City: JENSEN BEACH State:FL.
Zip Code: 34957 Fax:
Phone No. 772-834-2177
Address: 4715 S. U.S. HWY 1
City: FORT PIERCE State: FL.
Zip Code: 34982 Fax:
Phone No. 772-621-8282
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: REELPLUMBING@HOTMAIL.COM
State or County License: CFC1429318
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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
comme�np, work or reco-rdinR vour Notice of Commencement. ,_177
Rev. 8/2/17
gnatu-- f Owner/ Lessee/Contractor as Agent for Owner
Si lure of Contr for/Lice Holder
STATE OF FLORIDA. 11
J GLC
STATE OF FLO IDA- LLC
COUNTY OF T , .
COUNTY OF .5K ���
The forgoing instru eqwas acknowledged before me
this day of !v ai 20aby
The forgoing instrument w s acknowledged before me
this � day of / l �� 20_�&by
Name bf perso aking statement
Name of pe so aking statement
Personally Known (/OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature f Publil WAWA looM
(Signature of Notary
COMM 0 41
Commissio
p"IteIIsJ"
Commission No.
EMANUEL GAGE
' my COMMI # GG 116741
,, EXPIRES June 20, 2021
a'
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17