HomeMy WebLinkAboutBuilding Permit Application 2019-03-20 12:07 PM (EDT) To: +1 772-462-1578 From: +1 866-219-0729 Page 1/3
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:.,�- 21) - 19 Permit Number: ®� �
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5'.... - -: - RECEIVED
Building Permit Application MAR 2 0 2019
Planning and Development Services ST. Lucie County, Permitting
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: Plumbing
PftOPQSED IMPROV TENT LOCATION
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Address: 9512 CROOKED STICK LANE
Legal Description: POD 18 AT THE RESERVE PUD II FIRST REPLAT(PB 43-14)LOT 44A(OR 1902-1189)
Property Tax ID#: 3327-804-0008-000-7 Lot No.44A
Site Plan Name: Block No.
Project Name: BORGMANN
Setbacks Front Back: Right Side: Left Side:
s s S 'r "< , �' � �s "'� S`t '"=krdt i J"-•r.� R -..� k,µ+S N
50 GAL ELEC WATER HEATER REPLACEMENT
Additional work to hp pertorme un er t is permit-c ec+a a appy:
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors v�
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S .Ft.of First Floor: t
Cost of Construction:$ 1393 Utilities..
Septic Building Height:
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Name GLENN BORGMANN Name:
Address:16 LUNDY TERRACE Company: FLORIDA DELTA MECHANICAL
City: BUTLER State:NJ Address: 8402 LAUREL FAIR CIR SUITE.111
Zip Code:. 07405 Fax: City: State:FL
Phone No.973-879-4522 Zip Code: 33610 Fax: 866-219-0729
E-Mail: Phone No. 866-219-0880
Fill in fee simple Title Holder on next page(if different E-Mail FLPERMITS@DELTAMECHANICAL.COM j
from the Owner listed above) State or County License: CFC1425917 l
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
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2019-03-20 12:07 PM (EDT) To: +1 772-962-1578 From: +1 866-219-0729 Page 2j3'
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEESIMPLE 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.
certify that no work or Installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that its 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 most be recorded and posted on the jobsite
before th st inspe tion. If you intend to obtain financing,consul ith lender or an attorney before
-ornmenting)workoifreco4n vour Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORiV4 STATE OF FLORIDA
COUNTY OF 1-1i ([,; COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ay of 1rMY7.h ,20Lq by this day of�(Ylf?t�1- .h 20 19 by
1YY1 I t✓ �V btYYtt �. igcibf U
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally known_X_OR Produced Identification I
Type of Identification Type of Identification
Produced Produced
';�41-2- C
(Signature of Pu (Signature of Nota P EM LY H.MEDINA
2'Z7 ..
EMILY H.MEDiNA (�(� ZZ?C� Vii ?�..
;,: .* MY CO �ON#GG 227456
Commission No. ;_ li1YGf lWON#00227056 Commission No. ��Uunali,2022
EXPIRES:June tt,2022
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of ?r` IIpndedTfuuNataryPutrkcUtsdetvaitets
os i$•' 8ondW Thru Notary Public Undetwfts f,
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
'RECEIVED
DATE
COMPLETED
Rev.8/2/17
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