HomeMy WebLinkAboutDOC010721All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/7/21 Permit Number:
ST. Luc�E
Cou,N-T�y
F L O R I D A
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: GAS WATER HEATER
PROPOSED IMPROVEMENT LOCATION:
Address: 3808 PROMENADE WAY
Property Tax ID #: 2433-502-0034-000-4
Site Plan Name:
Project Name:
CHANGE OUT 50 GALLON GAS WATER HEATER
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: $ 500.00
Name MATT MITCHELL
Address: 388 PROMENADE WAY
City: FT. PIERCE State:
Zip Code: 34982 Fax:
Phone No. 772-233-3292
_ Generator
Sq. Ft. of First Floor:
Residential X
Lot No.
Block No.
_ Windows/Doors Pond
Roof Pitch
Utilities: —Sewer _ Septic Building Height:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: CHRIS JOHNSON
Company: CNJ PLUMBING LLC.
Address: 1701 S. 37TH ST.
City: FT. PIERCE State: FL
Zip Code: 34947 Fax:
Phone No 772-801-3073
E-Mail CHRISJOHNSON@FPUA.COM
State or County License 30950
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:
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 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 your N-tice of Commencement.
Signature of Owner a ee/ ontractor as Agent for Owner
Signature of Contractor/License older
STATE OF FLORIDA
STATE OF FLORIDA '
COUNTY OF .St' 4 [! /C
COUNTY OF SZ`: L(A C I f,
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 � day of �',g-�. , 202 by
_
this L day of 9-"1 , 2021 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
(Si nature of Notary P b 'c- t of lorida L(Signature
of Notar r'
,kA Po, MARTHA A KERR
Commission No. t ..:
?° •�" Notary Pt(f$i�al�tate of Florida
.:o�ppY "4L.. MARTHA A KERR
Commission No. ? ���'• �: Notary PublicgFlorida
• n Commission N GG 311213
F� My Contm, Expires Mar 22, 2023
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Commission # GG 311213
� of �o° ` My Comm. Expires Mar 22, 2023
h1fued
through Natio
al Notary Assn.
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Rev. 5/6/20