HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 18
1/2 Permit Number:
FNOV
EIVED "
Building Permit Application7 2018
Planning and Development ServicesBuilding and Code Regulation Division nty, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Y
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 2808 Kingsley Dr.
Legal Description:
Property Tax ID#: 1432-806-0105-000-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Gas 40 gallon water heater change out.
CONSTRUCTION INFORMATION:
Add itiona I work toe nertormed under t is permit—check a appy:
HVAC0 Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0✓ Plumbing Sprinklers E]Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 500.00 Utilities:In Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Dania S.Santamaria Name: Chris Johnson
Address:2808 Kingsley Dr Company: CNJ Plumbing
City: Ft. Pierce State:FL Address: 1701 S. 37th St.
Zip Code: 34946 Fax: City: Ft. Pierce State:"FL
Phone No.772-267-2999 Zip Code: 34947 Fax:
E-Mail: Phone No. 772-801-3073
Fill in fee simple Title Holder on next page (if different E-Mail: chrisjohnson@FPUA.com
from the Owner listed above) State or County License: 30950
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:1701 S.37th St. 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 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
commencingw
ork or recording our Notice of Commencement.
Signature of Owner/Lessee/Contra for as Agent for Owner Signe of Contractor/Licensel'older
✓" "i"o
STATE OF FLORIDA \ ppSTATE OF FLORIDA
COUNTY OF a L .1! `Nc/ COUNTY OF '4' . t L P,
Thef r, ing instrum t was acknowledge before me The forgoing instrume t was acknowledged fore me
this day of 20a by this day of 20 / by
( I h - 1
Name of son making statement Name of per making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifipwn Type of Identific
Produced l.— Produced
1 Cf�
(Signature of Notary Public-State of Florida) (Signature of Notary
KAREN S.
'°�'�
"y
NIELSEN
Commission No. ENI)ELSEN ;� �o State of FI%fflotary Public
REN Public Commission No. :. `
•' Commiss on GG 207484
YP
,,state of Florida-�GGa �748a �,' °P°•' My Commission Expiros
I ,OF 11\\��
Commission # iros June 12, 2022
,;mission Fxp
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REVIEWS SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17