HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ao Permit Number:
FCIE
EWS' tM Y i E i
F O 0 t p,..Ant
Planning and Development Services
Building Permit Application
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
PERMIT APPLICATION FOR: Water Heatr Replacement
PROPOSED IMPROVEMENT LOCATION:
Address: 10410 S Ocean Dr Unit 408
PropertyTax ID #: 4511-514-0026-000-7
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Install Rheem 38 Gallon Low Boy water heater under Air handler in closet - L U- -'�- Lr—
New Electrical Meter Second Electrical Meter.
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors ^ Pond
_ Electric -VPlumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction. $ 1,200.00
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
Name J0, rru-)) 6, I (16,!4 —4-zJ
Address: Id 1410 S 0Ca' e-rZ br2 �'
City: T cc n e 0 wc—� State: D.
Zip Code: 3495-3 Fax: -72 2-
Phone No. -7-1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: 1—on X-1.1 b 0 e-
Company: -5inSzn eqx- \
Address: 1616b N i'�CctfL i v
City: ! APyi State:P�-L-
Zip Code: 349 5-7 Fax: `772 -22S--io-17 9
Phone No i-1 2"- ZZS - la CQ®d
E-Mail 3aZkei.Q_ P a
State or County License Kw lID[� 37L2-L Q
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: _ 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 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 intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Martin
COUNTY OFMartin
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
x Physical Presence or Online Notarization
this ath day of September 12020 by
this stn day of September 2020 by
Lonnie Culberton
Lonnie Culberton
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
r
gnature oFNotary Public-
�ct Jotary Public State of Florida
g Willson
Commission No. GG275464 P M�jsSlon GG 275464
Expires 1 ���812022
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(Sig ture of Not Pub
p` Notary Public State of Florida
OmmIS510n NO. GG 275464 ., JaI��IViISon
sf MY Commission GG 275464
0i Expires 11/08/2022
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Rev. 5/6/20