HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:T� Permit Number: ��1 a^O�•��
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Building Permit Applica ionoPlanning and Development Services
Building and Code Regulation Division ST, LuclmlRiny '
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION
Address: 5692 TRAVELERS WAY
Property Tax ID#: 3410-503-0058-000-3 Lot No.
Site Plan Name: Block No.
Project Name: KERNER
DETAILED DESCRIPTION,OF WORK;
INSTALLATION OF AO SMITH 40 GAL WATER HEATER
CC►N STRU CTI O N.=I N FO R MAT I O NL
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric X Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:,
Cost of Construction: $ 850 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE;'F CONTRACTOR:
Name Robert Kerner Name:PAUL CLOUTIER
Address:5692 TRAVELERS WAY Company:FPL HOME SERVICES
City: FORT PIERCE State:_ Address:6001 VILLAGE BLVD
Zip Code: 34982 Fax: City: WEST PALM BEWACH State:FL
Phone No. Zip Code: 33407 Fax:
E-Mail:NA@NOMAIL.COM Phone No 561-747-5740
Fill in fee simple Title Holder on next page(if different E-Mail NATALIE.GOODSON@FPL.COM
from the Owner listed above) State or County License CFC1 30331
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.
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SUPPLEMENTAL:cONSTR'UCTION L'llEXLAW 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 J SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITUAVUR-bFIN E AN ATTQRNEY BEFORE RECORDING YOUR NOTICE MMENCEMENT."
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n to of 0 er/Lessee/Contractor as Agent for Owner §irrature of-Contractor/License Holder
STATE OF FL -Yr �� STATE OF FLO `��Q►
COUNTY OF ( � COUNTY OF
Theo oing ins e was acknowledgqby
efore me The f r_oing instrT e t as acknowled�ja efore me
s day of 20_ s day of 201 by
Name of person making statement. Name of person making statement.
Personally nown OR Produced Identification Personally Known OR Produced Identification
Type of I entificatio Type of Identificati n
Pro d Produced
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S' na ure of ota y Pu tc- to a notary public State of Florida I ature O'LL a- -
Ott P li o % o���or' ubl c State of Florida
GESELLA PAULINO : GESELLA PA LINO
°� �M�y1Commission GG 15145 My comrrli!jC@g1G 151455
Commission No. 'oOowv 'Wires 10/15/2021 CO mission No. 9 cry r Expires 100/15/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.