HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:5/19/21 Permit Number:
O
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 FOR: WATER HEATER
PROPOSED IMPROVEMENT LOCATION:
Address: 541 LA BUONA VITA DR
Property Tax ID#: 3425-664-0146-000-2 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
30GAL GALLON ELECTRIC WATER HEATER REPLACEMENT
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 k Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction. $ 169855 utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name LINDA SEGNELLO Name:RICHARD BASSOFF
Address541 I A RLJnNA VITA nR Company:ADMIRAL PLUMBiNG SERVICE,A SERVICE EXPERTS COMPANY
City: PSL state:FL Address:2895 JUPITER PARK DR#700
Zip Code: 34952 Fax: City: JUPITER State:FL
Phone No. 772-485-6208 Zip Code: 33458 Fax:
E-Mail)inda.segnello(�D_att.net Phone No 561-225-3356
Fill in fee simple Title Holder on next page(if different E-Mail 208PERMITTING@SERVICEEXPERTS.COM
from the Owner listed above) State or County License CFC1426115
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 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 1 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 our Notice of Commencement.
44ature of 0 e ssee/Contractor as Agent for Owner 5 n Lure of Con a License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
x Physical Presence or Online Notarization x Physical Pre en�+r¢r Online Notarization
this 19 day of may 202t by this 12 day of IVI Y 2024 by
RICRARD BASSOFF RICHARD BASSOFF
Name of person making statement. Name of person making statement.
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Id ntification
Pr uced Pro ce
( g ature of Not ublic-Sta F i a ature of N ry Public-State rofFlor4iaGG233150 ` tery Public State of F#o d 3 �' n a Lary Public State of o a
Cmmission N a° SeAtqueline Georgescu mrnission GG233150 �a cqueline Georges u
r_ Y My Commission GG My Commission GG 23 11
Expires 06/28/2022 Expires 0612812022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.