HomeMy WebLinkAboutForness_ permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 02/03/2021 Permit Number:
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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
Residential X
PERMIT APPLICATION FOR: Hot water heater-changeout
PROPOSED IMPROVEMENT LOCATION:
Address: 9500 S Ocean Drive, Unit 1604, Jensen Beach, FL 34957
Property Tax ID #: 4502-602-0148-000-0
Site Plan Name: n/a
Project Name: n/a
DETAILED DESCRIPTION OF WORK:
Hot Water heater changeout. Installing 40-Gallon Bradford White, electric, hot 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: $ 800.00
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: -Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Kim Forness
Name: Joseph Brownlow
Address: 4148 Middleman Park
City: Hamburg, NY State: _
Zip Code: 14075 Fax:
Phone No.716-238-6892
Company: Premier Plumbing and Air
Address: 108 NE Dixie Hwy
City: Stuart State: FL
Zip Code: 34994 Fax:
Phone No 772-692-2500
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
149 . _L
E-Mail preplbgac@gmail.com
State or County License CFC-1427780
"U%.vn1JGN INVULU UI s.UfTIInencernenL Is require a.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: Cite: 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 revle vi your deed for ary 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 Cosies 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTI F COMMENCEMENT."
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Signatur o wnerl Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA J /r
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STA-It OF FLORIDA
Ci��-
COUNTY OF ' hC,I�
COUNTY OF
The forging instrument was acknowledged before me
� day e b 2&QI by
Th4rAoing instrum otLw s acknowledged before me
this 20 day of P_ cA by
this of , -
S ew low
r0sIf . b,oLki-A b aj
Name of persoh 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
(Sign ture of Notary Pu F
Commission # GG 208194
Ex 17,2022
igna ure of Notary Public- St a of iiar4g e}-•. APRILBRUMLEY
Commission # GG 2081
Commission No.
...`°' BonTruroy F7in Nar9nce 600385 7
remission No. pl p�resApt�17,2022
1 �prded TMu Troy f
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
_
COMPLETED
Rev. 2/7 19