HomeMy WebLinkAboutPERMIT APP All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Hate: " Permit Number:
V i'-:
r i
Building Permit Application
Plonning and Development Services
Building and Code Regulotion Division Commercial Residential xxx
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: plumbing - water heater change out
PROPOSED IMPROVEMENT LOCATION:
Address: 375 NOTLEM DR Fort Pierce, FL 34982
Property Tax ID#: 3403-805-0026-000-5 Lot Na 8
Site Plan Name: Block No. 2
Project Name:
DETAILED DESCRIPTION OF WORK:
water heater change out 40 Gallon- 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 Windows/Doors Pond
_Electric `Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 388• Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Gerald L DevaneCharlotte W Devane Na me:PauI Cloutier
Address:375 NOTLEM ❑R Company:FPL Home Services
City: Fort Pierce State: Address:6001 Village Blvd
Zip Code: 34982 Fax: City: West Palm Beach State:FI
Phone N (772)461-0658 Zip Code: 33407 Fax:
E-Mail: Phone No5615298955
Fill in fee simple Title Holder on next page( if different E-Mail Desiree.Pacheco@FPL.com
from the Owner listed above) State or County UcenseCFC1430331
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State:_ City: 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 Counttyv makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conFlict with any applicable Home Owners Association rules,bylaws or an 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.
Inconsideration 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 Commence ust be recor blic records of St.
Lucie County and posted on the jobsite before the first i specti . If you int d o In ' arcing, consult
with lender attorneybefore commencin work or ecordin our ' e o o nC ent.
Signature of Owner/Lessee/Contracto gent for Owner Signature of Contract r/License Holder
STATE OF FLORADA STATE OF FIL A r7
COUNTYOF f a tW COUNTY OF Yn kNA eix CA/t
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
_�sical Presence or Online Notarization Physical Presence or Online Notarization
this day of M9Lf' 2020 by th' dayof M6t f'CJ4 .2020 by
�-a�lc� �.leynvtA, c� tz1 C` -1ot '�i-e�21"'
Name of person making statement. Name of person making statement.
P na nown OR Pr ed Identification� rsonally .own OR Produced Identification
ype of lde i ype of:den 'fication
Produced Produced
ignature of Notary Public-State re of NojPublic-Rux.SgW or my urY FStile alfilm
Commission No. Sal sireeAPachew a m Pacheco
GommnsswnGo 9 a05 m sion No. ` seim GG 985a95
ww 1,rspSlOe w4 Ea� Erp sasov9 02a
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGSEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REREVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.