HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ]
Date: 12/27/18 Permit Number: 4 4 (u
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1
-� -- 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
PROPOSED IMPROVEMENT LOCATION:
Address: 11311 S Indian River Dr.
Legal Description: 32 36 41 FROM NW COR OF LOT 13 BLK 1 HARRIS S/D RUN SELY ALONG ELY F
FEC RR 204.7 FT TO S LINE MAIN ST,TH E 565.34 FT FOR POB, TH CONT ELY 175 FT/L TO W
Property Tax ID#: 3532-412-0001-020-1 Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Removal and replacement of water heater with TruTankless Water Heater.
CONSTRUCTION INFORMATION:
Additional work to �]GasTank
orme under tis permit—checka appy:
❑HVAC ❑Gas Piping _Shutters �Windows/Doors
11 Electric �Plumbing Sprinklers En Generator Roof Roof pitch
Total Sq.Ft of Construction: Ft.of First Floor:
Cost of Construction:$ 1.200.00 Utilities Sewer 7Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name GP.nrnP. fL VaIPriP.limn Name: Arum Samnsnn
Address:11311 S Indian River Dr Company: Southpaw Plumbing and Metering Svcs
city: Fort Pierce State:FL Address: 1458 SW Bartell Ave
Zip Code: 34982 Fax: City: PSL State:FL
Phone No.772-214-9404 Zip Code: 34953 Fax:
E-Mail: Phone No. 772-486-0914
Fill in fee simple Title Holder on next page(if different E-Mail: adam@southDawwater.com
from the Owner listed above) State or County License: CFC1428285/29207
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: 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 recorde nd posted on the jobsite
before the first inspectio ou intend to obtain financing,consult with lendf r r an attorney before
commencing work or redprdiour Notice of Commence%nent.
Si ature f Owner/L /Co tractor a Agent for Owner Si nare of Contra /Lic a Hold r
STATE OF FLORIDA STATE F FLORMA
COUNTY OF COU OF
The forgoing instrument was acknowledged before me The forgoing instryment was acknowledged before me
this -day of ;. 20 by this_day of 20r by
i
Name of person?iiaking atement Name of person,making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced.
ignature of Notary Pu ic-State of Florida) (Signat`ure
Commi +' } ;? Commissi MYCQM poi 30
Cg MISSION#GG 022030 EXPIRES:September 1f,2020
M �'•;or iro� �1dld 1}MU NO�fy PIJflYC I�I<kJM�11B(S
EXPIRES:September 11,2020
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REVIEWS F ERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17