HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7/2 312 0 2 1
Permit Number:
IM
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Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial Residential XX
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax. (772)462-1578
PERMIT APPLICATION FOR:Plumbing
PROPOSED IMPROVEMENT LOCATION:
Address: 417 Willows Av Port St Lucie, FL 34952
Property Tax I D#f: 3419-510-0185-000-1
Site Plan Name: Lot No.
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace 40 gallon electric water heater(Like for like)
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: $ 1,000.00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Linda Pyatt Name: Gary W Zanello
Address:417 Willows Ave Company: Port St Lucie Plumbing
City: Port St Lucie FL State:_ Address:6907 Heritage Dr
Zip Code: 34952 Fax: City: Port St Lucie FL
863 634-9256 State:
Phone No, Zip Cade: 34952 Fax:
E-Mail: Phone No 772 468-6524
Fill in fee simple Title Holder on next page(if different E-Mail portstlucieplumbing@gmail_com
from the Owner listed above) State or County License CFG058025
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.
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
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Must b signed by owner/Agent and applicant:
xAl,
(Signauur c ntrac (Signature of Owner or Agent{including contractor})
State of Florida,County of S� L NC%� I State of Florida, County of
Affirmed to and subscribed before me this �U Affirmed to and subscribed before me this
a 3 20 Z 1 ,by 4ry W L,d/lie`/O 20 ,by
personally known to me or r whb has produced personally known to me or who has produced
as identification. ftidentifi ' '
Notary Signature: c 1 o Silai�t3e G�7 I� y �
iw: :' i;Hf1iS:11od 25,20
In jed Thru Ann Noy
Notary(print name) j 1�!L'`l� _� 1 Notary(print name)
Constmetion documents must accompany this application.The Florida energy code submitted becomes an integral part of this
plan and must pass final inspection."Notice: In addition to the requirements of this permit,there may be additional restrictions
applicable to this property that may be found in the public record of this county,and there may be additional permits required
from other governmental entities such as waste management district,state agencies,or federal agencies. "SIGNATURE OF THE
APPLICANT MUST BE NOTARIZED.If owner builder,applicant must sign in person.BUILDING PERMIT includes:
Building,Electrical,Plumbing,Mechanical,and Sewer only. All other trades require separate applications.
Asbestos compliance:It is the owner's or operator's responsibility to comply with section 469.003,Florida Statutes,and
to notify the Department of Environmental Protection of his or her intentions to remove asbestos,when applicable,in
accordance with state and federal law.
FEE SIMPLE TITLEHOLDER,BONDING COMPANY AND MORTGAGE LENDER INFORMATION IS REQUIRED WHEN
THE AGGREGATE VALUE(TOTAL COST OF ALL IMPROVEMENTS AND NOT JUST WORK AUTHORIZED BY THE
INDIVIDUAL PERMIT)IS$2500 OR MORE(EXCEPT HVAC REPAHMEPLACEMENT<$7500). PLEASE ADDRESS ALL
ITEMS.
Fee Simple itleholder's ❑Same as owner Bonding Company ❑Not Applicable
Name(if other than owner): Name:
Address: Address;
City: State: Zip: City: state: Zip:
Mortgage lender's Q Not Applicable
Name.
Address:
City: State: Zip:
OFFICE USE ONLY
Is the property located in a Special Flood Hazard Area(floodplain)per the current Flood Insurance Rate Map(FIRM)
❑Yes ❑No
Flood Zone: Reviewed by: Determination:
Permit Fee $ Other $ Plan Review Fee $
State Surcharge $ Other $ Routing Fee $
Subcontractor S Flood Review Fee $ Other $
Total Amount Due at Issuance $ Active Code Violation❑Yes❑No
Case#
Remarks Case Type _-
Reviewed by Date Final Check Date
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