HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: 718119- Permit Number: Alm
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Building Permit Application uzul 0.1. inr
Planning and Development Services 43/1I3J3�
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce'TL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential Y
PERMITTYPE:GAS WATER HEATER
- PROPOSErp IMPR"OVEIVIENT LOCATION '�, 's t} ` �' k, �- ;, Y-r- I
Address: 1803 HAZELWOOD DR.
Property Tax ID#: 2433-502-0025-000-8 Lot No.
Site-Plan Name: Block No.
Project Name:
DETAILED DESCRIyP1-IO.N OF UVORK 4
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CHANGE OUT GAS TANK WATER HEATER WITH GAS TANKLESS WATER.
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CONSTRUCTION{INFORMATION
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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 I
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction:$ 500.00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR y t
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Name MICHAEL S. OOSTDYK Name:CHRIS JOHNSON
Address:2710 WALKER DR Company:CNJ PLUMBING LLC
City: FT. PIERCE State:_ Address: 1701 S. 37TH ST.
Zip Code: 34982 Fax: City: FT. PIERCE State:FL
Phone No.772-528-2806 Zip Code: 34947 Fax:
E-Mail: Phone No 772-801-3073
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--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 THEJOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTE D TO OBTAIN FINAN , CONSULT
WITH YOUR MIDER OR AN ATTORN EFORE RECORDING YOUR NOTIC OF COMMENCEMEN
Signature of Owner/Lessee/Con or as Agent for Owner Si re of Contractor/Licens o
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF $ v P n COUNTY OF
The forgoing instrument was acknowledged before me The fp�r.going instrument was acknowledged before me
this� day of 1 20by this 'l� day of 201a by
Name of person making stateMent. Name of person maki g statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-Sta f Florida) (Signature of Notary Public- tate of Florida
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Commission No. ,q:,�s' �`b LAS RAM RAHMING :rpt>r,�ey ,, LASHAH RAHMING
MYrCO=hON#GG 275060 Commission No. e- N�°( M-
.• :t- MY COMMISSION#GG 275060
o- EXPIRES:Decembet"20,2022 EXPIRES:December;20 202
ded Notm .�• •••...F, Bonded Thru Notary ublic undenvdters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA R
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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