HomeMy WebLinkAbout52 Aqua Ra Water Heater PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: K ( CO {d()'d.Q Permit Number: _______ _
ST. LUCIE --~ COUNTY '
FLORIDA~ Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential _ _;... __ _
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
-----
Property Tax ID#: _______________________ _ Lot No., ___ _
Site Plan Name: ________________________ _ Block No. __ _
Project Name: _______________________________ _
DETAILED DESCRIPTION OF WORK:
New Electrical Meter ____ Second Electrical Meter _____ _
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical
Electric
Gas Tank
L Plumbing
_Gas Piping
_ Sprinklers
Total Sq. Ft of Construction: ______ _
Shutters _ Windows/Doors Pond
____ Pitch Generator Roof
Sq. Ft. of First Floor: ________ _
Cost of Construction: $ __:\_'2.--=S---==O~----Utilities: _ Sewer _ Septic Building Height: ___ _
OWNER/LESSEE:
Name TO d 45r0t:tb
Address: 5<1 AquC-\ Qg Or .
City: J""~ ~b State:PL...
Zip Code: ;>L/951 Fax:. ______ _
Phone No .. _____________ _
E-Mail: !Se()t et-tod cl(g hOtmo., J I col'()
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:T( rrotb~ Oo wnin
Company:TV"O,d\t{Q() P\urnbt~ LLC..
Address: \pga SE rYlO.nru-U);he
City: fb(t 'St . L-LU,-\ State: PL.-
Zip Code: 34.,,qi:3 Fax: _____ _
Phone No ,1cA-c71 -I a-s-8'
E-Mail T V'" o.c\ in O<"\ a\ U.Mb1 ·oo,.LLL@9roil.c
State or County License CF GI Lf 3 b[fcs-9
If value of construction Is 2500 or more, a RECORDED Notice of Commencement Is required.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: . ,;'
--. . -
DESIGNER/ENGINEER: _::L_ Not Applicable MORTGAGE COMPANY: ~ot 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 Coun~ makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con ict with a~ applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult th 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you i ntend to obtain financing, consult
with lender or an attornev before commencine: work or recordim~ vour Notice of Commencement. ~u / .J<'----\
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature ~n~r/License Holder
STATE OF FLORIDA sTATE oF FLORIDA s+ L e
COUNTY OF COUNTY OF .,/p(;,
Sworn to (or affirmed) and subscribed before me of ~o (or affirmed) and subscribed before me of
__ Physical Presence or __ Online Notarization ysical Presence or __ Online Notarization
this __ day of 2020 by this 4-day of th5 . 2020 by
·Ti'~~ DD!:(2a::1i e
Name of person making statement. Name ofprson making st'atement.
Personally Known OR Produced Identification __ < .,..Personally Kn.;m / OR Produced Identification
Type of Identification 1 y ..,= . --· .... ,cation
Produced Produced
/)
. .....-... --
(Signature of Notary Public-State of Florida ) ~ature of Notary Public-State o -/ ~-C::,'::] G,
Commission No. (Seal) Comm;,sfonNo.6bq @ '-~/ Ex;: '!=fs'
~.~,,,~ ..,.,;JIC: I h · .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20
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