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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: • Building Permit Application Planning and Development services Building and Code Regulation Division / 2300 Virginia Avenue, Fort Pierce FL 34982 V/ Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential Address: 113 NE Bracken Road, Port St. Lucie, FL 34983 Legal Description: RIVER PARK -UNIT 9 -PART C BLK 74 LOT 12 (MAP 34128N) (OR 1216-227) Property Tax ID #: 3419-570-0025-000-8 Site Plan Name: Project Name: DIETDERICH Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: Lot No. 12 Block No. 74 Drain and remove existing water heater in the Laundry Room. Supply and install new 40 gallon Rheem©* Classic'"" Atmospheric natural gas water heater. CONSTRUCTION INFORMATION: ❑HVAC Li Gas Tank Electric 0 Plumbing Total Sq. Ft of Construction: 2218 Cost of Construction: $ 1249.00 Piping ❑�_Shutters 11Windows/Doors IU nklers Generator L1 Roof ❑ Roof pitch S Ft. of First Floor: 2218 Utilities:nSewer Septic Building Height: 12 OWNER/LESSEE: CONTRACTOR: Name Lisa Dietdedch Name: James M. Ager Address: 113 NE Bracken Road Company: PLUMBING BY BISHOP City: Port St. Lucie State:FL Zip Code: 34983 Fax: Phone No.703-329-1857 Address: 2606 SE Willoughby Blvd. City: Stuart State: FL Zip Code: 34994 Fax: Phone No. 772-286-5872 E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail: info@plumbingbybishop.com State or County License: CFC -1429566 If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required. SUPPLEMENTAL CONSTRUCT( N LIEN LAW INFORMATION: Signa of Owner/ Lessee/C actor as Agen for Owner DESIGNER/ENGINEER: Name: Not Applicable MORTGAGE COMPANY:I Name: Not Applicable Address: The forgping instrument was acknowledged before me Address: this , day of /Y1/9f 20� by City: Zip: Phone State: City: Zip: Phone: BONDING COMPANY: Name: State: If Not Applicable FEE SIMPLE TITLE HOLDER: _Not Applicable Name: Address: Personally Known JL,-' OR Produced Identification Address: Type of Identification City: Produced City: Zip: Phone: Ignature of Notary PubI Zip: Phone: 1�y��� F'�"Y.LUCINE KHATCHERIAN CHAN 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 thepermit 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 t0 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 wit a or commencing work or recording our Notice of Commenceme Rev. 8/2/17 Signa of Owner/ Lessee/C actor as Agen for Owner Signature o cense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF 1-t6fZ 4 COUNTYOF 0AARJtily The forgping instrument was acknowledged before me The forgoing instrument was acknowledged before me M11 this , day of /Y1/9f 20� by this tWday of 20 /8 by riyyt5 rA,A A E' 2 <aW-fn c<. M. " f3' Name of personroakIng statement Name of person making statement Personally Known ✓ OR Produced Identification Personally Known JL,-' OR Produced Identification Type of Identification Type of Identification ProducTd i Produced (S n of otary Public4Z.: Ignature of Notary PubI - FI rida 1�y��� F'�"Y.LUCINE KHATCHERIAN CHAN LU/1CCcQIIN��7E11KHATCHERIANCHIN COmmIS510n NO.MYCOMMISSION # FF992 3f mmission NO. //``OO,,MY COMFIIIION # FF992837 EXPIRES May 16, 2020 EXPIRES May I6,2020 ] FbrMleNdaryawvb.cam (brl�-0153 F REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17