HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 03/12/20
COUNTY
F 1 A R 1 r.
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 Number:
Building Permit Application
Commercial Residential
PERMIT TYPE: Water Heater Tank Change Out
PROPOSED IMPROVEMENT LOCATION:
Address: 2123 Nettles Blvd - Jensen Beach, FL 34957
Property Tax ID #: 4502-501-0126-000-0
Site Plan Name:
Project Name: Water Heater Tank Change Out
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK:
Replace failed electric water heater with new Bradford White 50 Gallon Electric Water Heater in laundry closet.
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank i Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ :4'=' �
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Colleen L. Gerwitz
Name: Matthew T. Black
Address:2123 Nettles Blvd
Company: Benjamin Franklin Plumbing
City: Jensen Beach State: _
Zip Code: 34957 Fax: n/a
Phone No. 772-871-9494
Address:1631 SW South Macedo Blvd
City: Port St. Lucie State: FL
Zip Code: 34984 Fax: 772-871-9069
Phone No 772-871-9494
E-Mail:permits@benfranklinplumber.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail permits@benfranklinplumber.com
State or County License CFC1 430437
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.
DESIGNE
ENTAL CONSTRUCTION LIEN LAW INFORMATION:
ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ig`nature oTownerf Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA �{ ,1-� h1O STATE COUNTY
COUNTYOF FLORIDA
COUNTY OF &/'/ �%9 L
The forgoing instrums,�t,was acknowledged before me
this day of /"d"I f C"/ I , 20 Eby
Name of person making/statement.
Personally Known v OR Produced Identification
Type of Identification
Produced
The fo oing instrume t was acb nowledged before me
this day of 20�by
�4, -�-'/�/ , 4I
Name of person making statement.
Personally Known` OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- Spa '" ^ Ai10 L HERNANDE
Signature of Notary Public- S
My COMMISSION # GG0684
9
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r, rP•FI '. MARIO L HERNAND
Commission No.
; ,, &PhES January 26, 2021
ommission No. LZ Lr W
-M1( ISSION # OGOg
EXPIRES January 26, 202
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