HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/29/18 Permit Number:
e
BuildingPermit Application
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Planning and Development Services �E� ® G �
Building and Code Regulation Division ST. ;,:
2300 Virginia Avenue,Fort Pierce FL 34982 T:-dbele 1PFn ltt'l
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential�--- -..
PERMIT APPLICATION FOR: Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 9650 S Ocean Dr 707
Legal Description: THE PRINCESS OF HUTCHINSON ISLAND UNIT 707(OR 1124-394)
Property Tax ID#: 4502-610-0067-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
Removing old and installing new 40 gallon electric water heater.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
0 Electric 0 Plumbing Sprinklers E Generator 0—Roof Roof pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 700 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Mary L Pagel Name: Dale Hammond
Address:9650 S Ocean Dr#707 Company: For Him Plumbing
City. Jensen Beach State:FL Address: P O Box 1355
Zip Code: 34957 Fax: City: Jensen Beach State:FL
Phone No. Zip Code: 34957 Fax:
E-Mail: Phone No. 772-342-8677
Fill in fee simple Title Holder on next page(if different E-Mail: forHimplumbing@aol.com
from the Owner listed above) State or County License: CFC1428915
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:P O Box 1355 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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature o Contractor ice se Holder
STATE OF FLORIDA STATE OF FLORID /
COUNTY OFc.y�,✓X COUNTY OF �.✓�
The forgoing instrument was acknowledged before me The forgoing instrurp•qnt was pcknowledged before me
this.296day of 111.ojz nhzY_ ,20 (8 by this�`"/gday of 201&by
Name of persop making statement Name of personfnaking statement
Personally Known tt// OR Produced Identification Personally Known t/_ R Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-S ate of Florida)
t L`� "' "� rIALTER D PAYNE II (SeaI�WALTER D PAYNE II
Commission No. 11 '' P�o�,, Seal C mission No. �� z �Pa Pt B�
otary Public-State of Flor da ;r .o; Nota y Public-State of FI r a
= c Commission # GG 24467 •ti�: Commission # GG 244 7
M•Comm.Expires Au 5 "�� o:= MV Comm.Expires Aug 2512 0
'IFBonded I ttough National Notary ssn
Bond through National Notar
A n
REVIEWS FRONT NS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17