HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1907- U
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Building Permit Applicatio JUL 2 5 2018
Planning and Development Services $gel I i Fits ii ICI Department
Building and Code Regulation Division St. LUCIe ®(,,nth/ FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Plumbing
.PROPOSED IMPROVEMENT LOCATION:
Address: '?22 .55 My5T"/C Wily, llori- Sa.' + Lucie,, r(- 34 26
Legal Description: MYSTIC PINES AT THE RESERVE LOT 12 (OR 4130-2537)
Property Tax ID#: 3322-620-0017-000-4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install a new 50 gallon electric water heater in place of the,existing 50 gallon electric water heater.
Water heater is in the garage.
CONSTRUCTION'INFORMATION:
Additional work to be nertormed under tispermit-check all
appy:
HVAC Gas Tank ❑Gas Piping Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ (TC� Utilities"
_Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR: -
Name i N "T IN er- Name: 0 re14, -Q, 17c� Sp-f-4-
Addresss: 2Z iL W
Company: e'.1(�c, 6f_-hA ��LJ �iti1c, hf6
City:?O S i 1 u :4 State: -�L Address: '2-79q De-V i N '- Rb
Zip Code: 3 uj Q $6 Fax: N/A City: re)rnE?i ea-a-C State:rL
Phone No. 77 Z- q7/- f 13 L Zip Code: 3 4 9 g r Fax: AJ[A-
E-Mail: N 1A Phone No. 7 TZ IF79- 2-46 2-
Fill in fee simple Title Holder on next page(if different E-Mail: 0.dhiq 6 Ett pt<vhc )w Q I I<=a 9�6
from the.Owner listed above) State or County License: %F C,t u 2_9 q, I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'SUPPLEME'NTAL 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 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
commencing wor/k�1 or recording our Notice of Commencement.
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Signature of 0 ner/Lessee/Contractor as Agent for Ow f� f nature of ontractor/Licen4Holde = �
STATE OFF ORI D o 2S ATE OF FLORID .sM
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COUNTY OF m N UNTY OF >Lo
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The f r ng in um was acknowledg efore me ¢oa forgoing ins um t was geld before me ¢>Wthis dayof 20�by 4 M qday of 0/� by �
GL V ��� 1 • ca�i1 eQ=� �� '^�4*'bobs=
Name of per on making statement - am perso making statement
Personal own' OR Produced Identification + '" vhsonally Kno n OR Produced Identification
Type of Identi ionn Type of Identifi
Produced � �XA L Produced
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(Signature of Notaobric-state of Florida) (Signature of Notary blic-State of Florida)
Commission No. (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