HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I-Jg jg a � _ Permit Number:
0
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:WATER HEATER REPLACEMENT- LIKE KIND
PROPOSED IMPROVEMENT LOCATION:
Address: 6804 EDEN RD, FORT PIERCE, FL. 34951
Property Tax ID#: 1301-614-0091-000-6 Lot No. 1
Site Plan Name: LAKEWOOD PARK -UNIT 12- BLK 160 LOT 1 (MAP 13112S) (OR 375-1848) Block No. 160
Project Name: WATER HEATER REPLACEMENT- LIKE KIND
DETAILED DESCRIPTION OF WORK:
WATER HEATER REPLACEMENT- LIKE KIND - 40 GAL, ELECTRIC, MEDIUM AO SMITH UNDER WARRANTY
New Electrical Meter NIA Second Electrical MeterNIA
Fc—oNSTRUCTION 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: _
Cost of Construction: $ 600.00
OWNER/LESSEE:
Name HELEN WILSON
Address:6804 EDEN RD,
City: PORT ST. LUCIE, FL. State:
Zip Cade: 34951 Fax: N/A
Phone No. 772-871-9494
E-Mail: PERM ITS013ENFRANKLINPLUMBER.COM
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: MATT BLACK
Company: BENJAMIN FRNAKLIN PLUMBING
Address:6945 NW LTC PARKWAY
City: PORT ST. LUCIE State: FL
Zip Code: 34986 Fax: 772-871-9069
Phone N0772-871-9494
E-Mail PERM ITS@BENFRANKLINPLUM BER.COM
State or County License CFC#1430437
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:
A- Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to ontam a permit to av time wWr n ailu 1"a allPL:vt
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 l 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.
Lcie County and posted n the
f you intend to
n financing,
with lender or an attorney rcommencing
before e before twork orhe first irecprding Iourr Notice of Commiconsult
Commencement.
Signature �of o ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
ym0�� 36
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of identification
Produced
iA J;`= Notary RubHc •State of Florida
Commiss commission # HH 49124[Se
` Oct t, 2024
landed throw National Notary Assn.
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Signature of Contrac#or/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known f OR Produced Identification
Type of identification
Produced
(Sikhatur fr "i y F'ub116CI�tJ il?+r�Cx it'd 1
P Notary Public • State of Florida
Commissl Commission # HH 49124 (S 1�
of .: omm. pares Oct 1, 2024
Bonded through National Notary Assn.
ZONING SUPERVISOR I PLANS VEGETATION I SEA TURTLE MANGROVE
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