HomeMy WebLinkAbout113 CAMELOT DR.All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/11/21 Permit Number:
O
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 L'OCgTION:*
r
Address: 113 CAMELOT DR.
Property Tax ID #: 1432-801-0045-000-6
Site Plan Name:
Project Name:
CHANGE OUT 40 GALLON GAS WATER HEATER.
New Electrical Meter Second Electrical Meter
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
_ Generator
Sq. Ft. of First Floor:
Residential X
Lot No._
Block No.
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer _ Septic Building Height:
Name BERNICE PRESSELY I Name: CHRIS JOHNSON
Address: 113 CAMELOT DR.
City: FT. PIERCE State:
Zip Code: 34946 Fax:
Phone No. 772-332-1736
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Company: CNJ PLUMBING LLC.
Address: 1701 S. 37TH ST.
City: FT. PIERCE
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.
State: FL
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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 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 attornev before commencine work or recording vour Nitice of Commencement.
Signature of Owner a e/ ontractor as Agent for Owner
Signature of Contractor/License older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF St c/�'
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 � day of ;:rAU. , 202JLby
this ' L day of ,, f A , 2021 by
Name of person making statement.
Name of person making statement.
Personally Known w�� OR Produced Identification
Personally Known OR Produced Identification
-
Type of Identification
Type of Identification
Produced
Produced
' A
b •c- t of lorida
(Signature of Notary PI!V-
(Signature of Notar
Pgv poMARTHA A KERB
No. ` •. Notary Pt(f 011tate of FloriJda
'<►�'! PG; . MARTHA A KERR
s o -Commission
Commission No. =r % �'• ^ Notary Public - $fioFlorida
Commission N GG 311213
z dr f� My Comm. Expires Mar 22, 20
ommission fj GG 311213
or My Comm. Expires Mar 22, 2023
"Cu through Nation
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