HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/10/19 Permit Number:
�}yy"+ 9
'`°'"1
Building Permit Applica ion DEC 10 2019
Planning and Development Services
Building and Code Regulation Division Pe m tt i n a €1 e p a rtS"3"i O n
2300 Virginia Avenue,Fort Pierce FL 34982 : _ Cie County, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Re
PERMIT TYPE:GAS WATER NEATER
PROPOSED IMPROVEMENT LOCATION:
Address: 1704 CORTEZ BLVD.
Property Tax ID#: 24241-244-0020-000-5 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-
Name
'CONTRACTOR:
Name ROBYN BURGDOFF Name:CHRIS JOHNSON
Address:1704 CORTEZ BLVD. Company:CNJ PLUMBING LLC
City: FT.PIERCE State:_ Address:1701 S.37TH ST.
Zip Code: 34982 Fax: City; FT. PIERCE State.FL
Phone No.772-252-4127 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.
I
' _..as..'�,-. ..�..;^ _,.�: '..-,.....,— .. ,�-,.;„>' r� -� .�as a s„ s. ,,..,,r.w ..tik.�m���•..4.,.�,�-_r ,x",b�rsx.�:.�.�� +i -.,r.,es ... ,�_-� ..3 s.._c' pp tim9 c'e- �m�-,...„
DESIGNER/ENGINEER. _Not Applicable MORTGAGE COMPANY: _Not A licable
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 BEFO E THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FIN CING, CONSULT
WITH YOUR L DER OR ANA NEY BEFORE RECORDING YOUR NOTIC F COMMENCEM "
gnature of Owner/Less e ontractor as Agent for Owner Signature of Contractor/License bider
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fgrgoing instrument was acknowledged-before me The fgrgoing instr nt was acknowledge�efore me
this F day of 201 -by this / day of 20 Lam•` by
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
(Signature of Notary ublic-State of Florida) (Signature of Nota ublic-State of Florida) '
Commission N AUDREY B.H WP EY
MY MISSIOt � 300817 Commissi N y.. A!?QREYR•HUMPHR aI)
*: `•*= i '? = MY COMMISSION i!GG 300817
MaFeh 6,2023
EXPIRES:March F,2023 Ni r =
•„QF F��• Bonde Thru Nctiry•.u�”: e ;-.: :
REVIEWS I l"G SUPERVISOR PLANS pF Sondedl'huNotaryPubli?VT4-4--- NGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
'RECEIVED
DATE
COMPLETED
iev. 2/7/19