HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: 412119 Permit Number: `�c �11
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RECEIVED
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- - - Building Permit Applica ion
Planning and Development Services T; t Nyld 1z;
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Building and Code Regulation Division
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2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Y
PERMITTYPE:GAS WATER HEATER
PROPOSED IMPROVEMENT LOCATION:
Address: 103 HILTON DR.
Property Tax ID#: 1432-805-0037-000-9 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CHANGE OUT 40 GALLON GAS WATER HEATER.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 500.00 Utilities: —Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name JACQUELYN A.WILLIAMS Name:CHRIS JOHNSON
Address:3162 BOLLARD RD Company:CNJ PLUMBING LLC
City: WEST PALM BEACH State:_ Address: 1701 S. 37TH ST.
Zip Code: 33411 Fax: City: FT. PIERCE State:FL
Phone No.772-831-3888 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.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR A r TORNEY BEFORE RECORDING YOUR NOT1QrOF COMMENCEM "
Si ature of Owner/Lem /Contractor as Agent for Owner Signature of Contractor/Licens Holder
STATE OF FLORIDA - STATE OF FLORIDA
COUNTY OF 5 L0` COUNTY OF SA �-O,;X$
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisa- day of 6% Z. \ ,20VA by this a. day of Qit c�\ 120_A by
�V,.�6a� �`n•c S �dlnrsor
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced V)L
(Signature of Notary blic-State of Florida) ure of N'; " .. . p GIVENS
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�dARiE GN NS ='' " My COMMISSION#GG 022023
Commission NO.G�da`ad�•3! a DFA�NA GG0 1m SIOn N0. d IRES:Decem( 1&, 020
7o,FwY Pu9"`�,,. MY C�Mr�,SSmbQt 1 ,202 =;�F�F F;o;.� Bonded Thru Notary Pubblic Unad'envriiers
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DATE
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DATE
COMPLETED
ev. 2-1713.9