HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED \
Date: 4 1�� Permit Number: baro' (3 u 1 c�1(0_
RECEIVED
- JUN 19 2018
Building Permit Applicati n
Planning and Development Services ST. Lucie County,Permittins
Building and Code Regulation Division '
2300 Virginia Avenue,Fort Pierce FL 34981
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line LJ c�,Jc ir
PROPOSED IMPROVEMENT LOCATION:
Address: 11311 S Indian River DR.
Legal Description: 32 32 61 FROM NW COR OF LOT 13 BLK 1 HARRIS S/D RUN SELY ALONG ELY F
R/W OF FEC RR 204.7 FT TO S LINE MAIN ST. TH E 565.34 FT FOR POB, TH CONT ELY 175 FT
Property Tax ID#: 3532-412-0001-020-1 Lot No.
Site Plan Name: JUNO WATER HEATER Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
REMOVE EXSISTING 15 GAL. ELECTRIC WATER HEATER FROM ATTIC AND RELOCATE TO
GARAGE WITH NEW 20 GAL. ELECTRIC WATER HEATER
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC []Gas Tank ❑Gas Piping 1J Shutters F]Windows/Doors
Electric 0 Plumbing Sprinklers E_Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1200 Utilities:r I Sewer R1 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name C1V��\U1.10 Name: tD�FI fY� SMP�1�
Address: I) 311 S 11'1 Oi lPiN e-1 AfZ C>RZ Company: `)
City: -FER—T tW—CF state:4--t Address: I4 S-6 W
Zip Code: ..�24c'I!F�2- Fax:�c r�,'�— City: �S� '�fi State:
+"� FL—
Phone No. U - 3� - 4-CIF�r- Zip Code: _35t-�rw Fax: �2'324-(pS
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail aC_1 C.
from the Owner listed above) State or County License: k'6AO1
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: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 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 thepermit holder to build the subject structure
which is in conflict 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
commencing work or recording our Notice of Commencement.
Si ure of Owner/ /Contract r as Agent for Owner SignatqreNpf Contractor/ ice a Holder
STATE OF FLO A STATE OF FLORS�DA
COUNTY OF � �� COUNTY OF '>i 1_
The forgoing instr ment was acknowledge before me The fogging inst me t was acknowledged before me
this day of _ 20� by this ay of 201L by
NV)_n 1=)nu — ss�n
Name of pers making statement Name of perso makin statement
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
= tiM1•., s SARAJOHNSON
„nrr..,. qARAJOHNSON My COMMISSION A GG 0220:
(Signature of N ublic-St of �'F;ga�1YCOMMISSION#GGO 139ig ture of N ry Public- ' idOXpIRES:September 11,202
EXPIRES:September 11, 020 `•;p'.�oa Oorded ThN Notary public Undero
Commission Not, : ThruNotarypubkU m1nowission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17