HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/28/18 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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
I PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description: CORAL COVE BEACH -SECTION ONE- BLK 4 LOT 44 (OR 3652-2431)
Property Tax ID #: 1
Site Plan Name:
701-0108-000-7
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
REMOVAL AND INSTALLATION OF NEW 40 GAL ELECTRIC WATER HEATER, LOCATED IN THE
GARAGE.
I CONSTRUCTION INFORMATION: III
HVAC IIGasTank
E]GasPiping
LIShutters
_
Name:
Company:
Windows/Doors
Electric Plumbing
Sprinklers
Generator
11
Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ q—+5 C)u
S Ft. of First Floor: _
Utilities: � Sewer F Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company:
Address: 241 BERMUDA ULAUH UH
City: F State: _
Zip Code: 34949 Fax:
Phone No. 1/2 -b1/ -U433
Address: 1458 SW BAR I ELL AVE
City: PO LUUIE State:
Zip Code:34953 Fax: 24 -6531-
Phone N 4_
E -Mail: A
E -Mail: TL UOM
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
State or County License:
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
IC
Address:
The g instr ent was acknowledge�hefore me
rYay
City:
Zip: Phone
State:
City:
Zip: Phone:
State: _
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of Identification
Address:
Pro ce
City:
City:
-'
Zip: Phone:
22030
Zip: Phone:
pF
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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
commencins work or recordinemour Notice of Commencement.
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/LLlc se Holder
STATE OF FLO A,i
COUNTY OF
STATE OF FLORI `
COUNTY OF I I
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IC
The forgoing instryment s acknowleda efore me
The g instr ent was acknowledge�hefore me
rYay
this day of .11 a� . 200by
thisof 20�b by
aYA r VA O rel' 1
Name of pers9� making statement
Name of pe rso maki g statement
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Pro ce
(ignature of of p �I ic- tate y,;. N
(Signature of No
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22030
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MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17