HomeMy WebLinkAboutSampson_Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/30/2020 Permit Number:
L L V7D E� Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Water heater changeout
PROPOSED IMPROVEMENT LOCATION:
Address: 8750 S Ocean Drive, Unit PH-42, Jensen Beach, FL 34957
Property Tax ID #: 3535-601-0096-000-6
Site Plan Name: n/a
Project Name: n/a
DETAILED DESCRIPTION OF WORK:
Hot water heater changeout. Installing AO Smith -40-Gallon Hot water heater, Electric.
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ 850.00
Generator
Sq. Ft. of First Floor:
Lot No._
Block No.
Windows/Doors _ Pond
Roof Pitch
Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Pat Sampson
Name: Joseph Brownlow
Address: 8750 S Ocean Drive
Company: Premier Plumbing and Air
City: Jensen Beach, FL State: _
Zip Code: 34957 Fax:
Phone No. 802-338-2737
E-Mail:
Address: 108 NE Dixie Hwy
City: Stuart State: FL
Zip Code: 34994 Fax: 772-692-1094
Phone No 772-692-2500
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail preplbgac@gmail.com
State or County License CFC-1427780
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
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 ao the worK ana 1MLc1iidiivii dz, 111u1t.0«
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
structure. Pleahich is in se conlict sth any ult withyourHle Home Owners Assoc ome Owners Association aond review ylaws or your de a for oveyrnts that restrictions which ma oa prohibit such
Y 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 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
TH YOUR LENDER R AN ATTORNEY BEFORE RECORDING YOUR NOTI IFCOMMENCEMENT."
WI
Signatur o wnerl Lessee/Contractor as Agent for Owner Signatgre of Contractor/License Holder
STATE OF FLORIDA 1 /r STA OF FLORIDA /
COUNTY OF �(fCI __ COUNTY OF L U C/�
The forgoing instrument was acknowledged before me The forizping instrume t as acknowledged before me
this Q_ day of k(GV 20 — by this Y2ay of V 20 -Dby
S rr bl,� i� .. 01 j6-owl lb c')
Name of persoA making statement. Name of person imaking statement.
Personally Known X OR Produced Identification Personally Known _�_ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
i
n Q - —4-)JO - - -
(Sign ture o"tP F igna ure of Notary Public- St e of lorldRg'�-APRILBRUMLEY
Commission # GG 208194 �; Commission#GG2081Commission .`s` Fx 17'20� 2022
mmission No. "%l sAprill 17'
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z/7/19
Rev. Z/7/19