HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 03/30/2018 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 4
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5808 Cassia Or-Fort Pierce, FL 34982
Legal Description: INDIAN RIVER ESTATES-UNIT 09-BLK 82 LOT 2(MAP 34/12S)(OR 864-2778).
Property Tax ID 11: 3402-610-0350-000-4 Lot No.82
Site Plan Name: Block No, 2
Project Name: Water Heater Replacement
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I
Install a 40 gallon AO Smith electrical water heater tank in garage.
CONSTRUCTION INFORMATION:
Aaamonal worK to ��e aeI orme under t is permit—checka apply:
l❑HVAC Gas Tank ❑Gas Piping �_Shutters Windows/Doors
1.(Electric ❑✓_Plumbing Sprinklers 11 Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 975.00 Utilities: Sewer Septic Building Height:
OWN'ER/LESS E' ,., N, CONTRACTOR:
Name Barbara Hodges Name: Robert W.Ludlum
Address:5808 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.772464-0694 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: CFC1426801 /SLC23584 I'
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:Bamara eedeea Name:Robert W.Ludlum
Address:sane cauia or-Ron Pim.,FL ezeez Address: semcasuaor
City: Fonpit— State:_ City: Pon& Lua• State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:1631 SW south Maoeeo Bim 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 thedpermit holder to build the subject structure
whichisincon lot with any applicable Home Owners Association rules,bylaws or an 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
cornmencing wo r rdin o o ice of Commencement.
Signat p Owner/LesWContracror as Agent for Owner Signature of Contractor/ nse Xolder
STATE Of FLORIDA `y STATE OF FLORIDA
COUNTY OF Sz�L// Pi COUNTY OF
The foo��ggp�ing instrum was a nowle lgekbefore me The far oing Instru ent w acknowledg before me
this3p dayof l / 20/-6 by this]Eday of 20byy
Aheil W, l 4lulm I L f
Name of persoym�aking statement Name of person aking statement
Personally Known ✓ OR Produced Identification Personally Known I,OR Produced Identification
Type of Identification Type ntification
Pr uced
yijLaL1
(Signature of Notary Public-State o to ida) (Signs re of Notary ublic-State cf rida)
Commission No.&J&&J5ili(Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
.. BUILDING & CODE REGULATION DIVISION
S ' J 2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE:
Permit #
Credit Card Users: 1.501b Surcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA _ MASTERCARD
Credit Card Number 3 75-/
Expiration Date /✓/ZO;U Zip Code R�f9fl
3 digit security code '' .3/f6
Amount $ 86.09 + 1.5% surcharge
Business Name: Cerra
Authorized Signature: ��LL
Print Name: /17CiYiP �• YfL' L
Phone: ( 771—) .h'7/
Fax: r 77z) ell - ydG 9r
Comments:
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SLCPDSD Revised 4/01/2010 EN