HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06/19/2018 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 J
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 13377 S INDIAN RIVER DR - JENSEN BEACH, FL 34957
Legal Description: 9 37 41 FROM NE COR GOVT LOT 3 RUN N 89 DEG 06 MIN W 130 FT TO POB, TH CONT N 89 DEG 08 MIN W292.83 FTMIL TOE RIWFEC RR, THNWLV ALG SD E RM 185 FT MIL TO S LI EDENIAWN PLANTATION INC, TH N65 DEG
40 MINE 324 FT, TH N 64DEG E 270 FT M/L TOW SHORE IND RIV, TH SLY ALG W SD SHORE 120 FTWL, TH $ 61 DEG 05 MIN W310 FTMIL, TH S20 DEG 52 MIN E 172.89 FT TO POB -LESS SR 707- (OR 2278-2190; 3551-283)
Property Tax ID #: 4509-130-0008-000-0 Lot No.
Site Plan Name: Block No.
Project Name: WATER HEATER TANK REPLACEMENT
Setbacks Front Back: Right Side: Left Side:
DETAfLED DESCRIPTION OF WORK:
Install AO Smith LP Gas tank -style water heater behind blue North building in shed.
Additional work to be ertormed under this permit — cneck all n apply:
HVAC f Gas Tank E]Gas Piping _ Shutters Windows/Doors
Electric 71 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 650.00 Utilities:cnSewer 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Edenlawn Holdings LLC dba 12 Keys Rehab
Name: Robert W. Ludlum
Address: 13377 S Indian River Dr
Company:
City- Jensen Beach State: _
Zip Code: 34957 Fax: n/a
Phone No. 772-871-9494
Address: 1631 SW South Macedo Bovd
City: Port St Lucie State: FL
Zip Code: 34984 Fax: 772-871-9069
Phone No. 772-871-9494
E -Mail: n/a
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: Permits@benfranklinplumber.com
State or County License: CFC1426801 / #23584
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
IGNER/ENGINEER: _ Not Applicable I MORTGAGE COMPANY: Not Applicable
Name: Edenlawn Holdings LLC dba 12 Keys Rehab
Address: 13377 S INDIAN RIVER DR - JENSEN BEACH, FL 34957
City: Jensen Beach State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address: 1631 SW South Macedo Bovd
City:
Zip: Phone:_
Name: Robert W. Ludlum
Address: 13377 S Indian River Dr
City: PortSt Lucie State:
Zip: Phone:
Not Applicable I BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 th lender or an attorney before
commencine weak or re�tord)� R vour Notice of Commencement./l. .'
Rev. 8/2/17
Signature of Contr c or/License Holder
SignakulVof Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA.i y
COUNTY OF .� f>°
COUNTY OF Z2 ai1r1�1L�G
The forgoing instrLPent was acknowledged before me
The forgoing instru ent was acknowledged Pefore me
C
this q day of '20 by
this ( day of 20 by
' '
Lu
Name ofp erson%�akin statement
Name of person m king statement
Personally KnownOR Produced Identification
V
Personally Known _/OR Produced Identification
TyQe01Identification
Type of Identification
Pro ced
Produced
v
10 L HERNANDEZ
ignature of Notar p i'ti i NANDEZ
(Sign ture of Notar 3'u - f MMMIlSSION # 0GO66499
I '= COMMISSION # GG066499
'? PIRES January 28, 2021
Xv
Commission No. PIREtilltary 26, 2021
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