HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/22/2019 Permit Number:
J61BRAL�
-
lllillillillivillilliillo 11 111 mill
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: Water Heater
PROPOSED IMPROVEMENT LOCATION:
Building Permit Application
Commercial Residential X
Address: 1352 Nettles Blvd, Jensen Beach, FL 34957
Property Tax ID #: 4502-507-1539-000-5 Lot No
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
install 40 gallon electric Rheem water heater in closet
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
Electric 4 Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction., Sq. Ft. of First Floor:
Cost of Construction: $ 750.00 utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name John Anderson
Name: t
i
1352 Nettles Blvd
l lAddress:Company: Z;A
City: Jensen Beach State:
Zip Code: 34957 Fax:
Phone No.(239) 246-5707
Address: 31-7 r i I t
C .e
City: A`2"L
Zip Code: '���� Fax:
Phone No
E-Mail
Stater
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License.L
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:
DESIGNERIENGINEER:
_ 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: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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, f 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 your Notice of Commencement.
w _
'Siginature of Owner: set Contractor as Agent for Owner gnature of Contract6r/License4o°Ider
STATE OF FLORIDA,- STATE OF FLORIDA
COUNTY OF - =, ' ` `% COUNTY OF - 0 e,
The forgoing instrument was acknowledged before me The for Ding instrument was acknowledged before me
thi�4 day of t T� 20 Aby this��day of �_ _ 120 by
(Name of person acknowledging } (Name of person acknowledging)
(sign atu"re of Notary Publi€ - State of Florida)
y g e,rgw _ Prdd~1N6 t'tI'fFZA Z
Personally Known *"' commission# GG 3715
Type of Identificati `
q� t y Uommissian Expires'
Commission No.
Revised 07/15/2014
'(Signature of Notary Public- State of Florida) "
Personally Known - R PrMdgdeJATfl�CdtQf}i Z
.,,
Type of Identificati * o commission # GG 97150
:*
�tF My Commission Expires
April
Commission No. '�.;";,:021
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