HomeMy WebLinkAboutPERMIT APPLICATION FOR 21100 GLADES CUT OFF ROAD, PSL, FLAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/03/2020
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential X
PERMIT APPLICATION FOR:OS WATER HEATER REPLACEMENT LIKE KIND
PROPOSED IMPROVEMENT LOCATION:
Address: 21100 GLADES CUT OFF ROAD, PORT SAINT LUCIE, FL 34987
Property Tax ID #: 4221-231-0005-000-6
x13739 FROM NE CDR OF SECTION R1N S99 DEG 55 MIN WAEONGNLtl{F OF SEGTlONT XFT 7O NW-* R'NGiADESGuTCFF RJ
Site Plan Name,
Lot No.
Block No.
Project NaMe:
TH8440E043MINmsECW3747.uFTF0RP6S7HN45OEGINMWMECW16%FT.7N544CE 43M&�SECW'164FT7If545CE016MM 15ECE16GFTToAPTON-1,uDWIYRl1 W-1,N440EG41MIN305Ef.E.T FTTJ�
DETAILED DESCRIPTION OF WORK:
REPLACEMENT FOR LIKE KIND RHEEM TANKLESS LP GAS WATER HEATER ON OUTSIDE OF HOME BY BACK PORCH
OWNER SUPPLIED
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 ! Windows/Doors Pond
Electric _ Plumbing _, Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 540.00
OWNERAESSEE:
Name IRA OR MICHELLE SMITH
Address:21100 GLADES CUT OFF ROAD
City: PORT SAINT LUCIE State:
Zip Code: 34987 Fax:772-871-9069
Phone No.772-871-9494
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
E-Mail: PERMITS@BENFRANKLINPLUMBER.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: MATT BLACK
Comnanv:BENJAMIN FRANKLIN PLUMBING
Address:6945 NW LTC PARKWAY
City: PORT SAINT LUCIE State: FL
Zip Code: 34986 Fax: 772-871-9069
Phnnp N0772-871-9494
E-Mail PERMITS@BENFRANKLINPLUMBER.COM
State or County License CFC-1 430437
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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, wails, 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 rec.o.r-ing your Notice of Commencement.
/y'of
Signature Owner/ Lessee/Contractor as Agent for Owner Signature Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this _-5— day of 94 tall b4A - , 2020 by this S_� day of J,,neLaw b&_. 2020 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signat re u Icy 0ffi(Signatu •ary Pu} ka-A 14bKohEhVrl a
t ?g Notary Public . State of Florida
$ Notary Public -State of Florida commission; HM 49824 r
Commissio Commission k Hit 49�13�a1j Commis Oct i 2024 al}
MY ices Oct S, 2i)24 Bonded through National Notary Assn.
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE I MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED —
DATE
COMPLETED
ev.