HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED g
Date: 1/12/2021 Permit Number:
La cm
v � � 0111 . 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 r OR:WATER HEATER CHANGE OUT
PROPOSED IMPROVEMENT LOCATION:
Address: 140 Ocean Bay Dr
Property Tax ID #. 3522-608-0027-000-3
Site Plan Name: Robert Burns
Project Name: Robert Burns
DETAILED DESCRIPTION OF WORK:
INSTALL 50 GALLON AO SMITH WATER HEATER
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
CONSTRUCTION INFORMATION: I
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: $ 1,185.00
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Nam y ' a,i.4- , n
Name: Paul Cleary
Address: _eC�t2� 'Q)"L:l
City: 'State
Zip Code: �j� _i Fax: _
Phone No. l .- Q S
E-Mail: L�11)cnj 4 LyA y Vi {7"'—
Company: Cleary Plumbing
Address:1011 8th Ave South
City: Lake Worth State:FL
Zip Code: 33460 Fax:
Phone No561-790-1956
Fill in fee simple Title Holder on next page ( if diffAW00
from the Owner listed above)
E-MaiISERVICE@CLEARYPLUMBING.COM
State or County License CFC-1425743
1Yc11utl Ur %.Ur1sL1ur uvr1 is zauu or more, a Kra.UKUtV Notice of Lommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPipI�ENi ENTAL C(]NSTRUCfiI
c 4s ;kit •[, '; � ? �
N L[EN LAW{lNFdRMATiO{
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1 3i i z t- ,'
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zi p: 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 IPnriPr nr an attornev before commencinE work or recorc"votdr,Notice of Commencement.
i nature o Ow Lessee/Contractor as Agent for Owner
Sig ature of Conti r/License Holder
STATE OFF RIDA
STATE OF FLORIDA
COUNTY OF C
COUNTY 0F4-
Sworn (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
L iysical Presence or Online Notarization
this day of cry �d ZOZ(� by
this Zday %offl Aa s cJi 2024 by
U
ame of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known V—OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
of No
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(Si f Notar
o -
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Ai�;��KIEIY
Commission No.
�t 1COht.4566f'),970
Commission No.Ir°<YCO
A�tl j�s��j!GG3075705,2023
lar$tivrlfare
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20 W11 KIMBERLYANNKIELY
; U�t • a g,�� KIMBERLY ANN KIELY
MY COMM1SS10t1 # GG 307970 iAP AV�'I,
` MY COMMISSION # GG 307970
Bonded Thru Notary Public Un derv+dlers
Banded Thru Notary Public Underwriters