HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 03/13/20 Permit Number:
MENEM_
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: Water Heater Tank Change Out
PFt4PpSE[? i.11%1PRf3VE EN , 0CATI�N'
Address: 9500 Crooked Stick Ln - Port St. Lucie, FL 34986
Property Tax ID #: 3327-804-0002-000-5
Site Plan Name:
Project Name: Water Heater Tank Change Out
Lot No. 38A
Block No.
Replace failed electric water heater with new 50 gallon Bradford White electric water heater tank in garage.
Additional work to be performed under this permit — check all that apply:
—Mechanical _Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric -V/Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ `1 �/ �� 00
Name Frederick C Ballard Jr & Nancy B Ballard
Address: 9500 Crooked Stick LN
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
City: Port St Lucie State:L
Zip Code: 34986 Fax: n/a
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)
Name: Matthew T. Black
Company: Benjamin Franklin Plumbing
Address: 6945 NW LTC Pkwy
City: Port St Lucie State. FL
Zip Code: 34984 Fax: 772-9069
Phone No 772-871-9494
E-Mail Permits@benfranklinplumber.com
State or County License CFC1430437
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
Not Applicable
State:
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."
Signature of Owner/ ssee/Contractor as Agent for Owner
STATE OF FLORIDA ,
COUNTY OF C
The forgoing instrum t was acknowledged before me
this day of ' /i 20
Name of person making statement.
Personally Known j OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public
Commission No.
HE
Signature of C tra or/License Holder
STATE OF FLORIDA �r
COUNTY OFf!`P
The for�ing instrum was ack wledged before me
this day of % � " 20
Name of person making statement.
Personally Known P% Oft Produced Identifi
Type of Identific
Produced , ; • MARIO L HERNA
ARIO L
RNAND
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f•,�,, ')i�E9 .)�nuary .ti, 2Q2
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
( ignature of Notary Public- State of A
ommission Nq.
GGKC1498
26, 2021
a)
(Seal)
SUPERVISOR PLANS I VEGETATION I SEA TURTLE I MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
( ignature of Notary Public- State of A
ommission Nq.
GGKC1498
26, 2021
a)
(Seal)
SUPERVISOR PLANS I VEGETATION I SEA TURTLE I MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW