HomeMy WebLinkAboutEPSON022All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date :10/14/2021 Permit Number:
Planning
Building
2300
Pho
O .:, Building Permit Application
and Development Services
and Code Regulation Division Commercial Residential X
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578
PERMIT
APPLICATION FOR: Water heater replacement
PROPOSED
IMPROVEMENT LOCATION:
Addr
ss: 250 Shinn Rd
Property
Site Plan
Tax ID #: 2307-422-0001-000-1 Lot No.
Name: Block No.
Project
Name:
DETAILED
DESCRIPTION OF WORK:
Remove
and replace water heater located in laundry room.
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
' Electric )� _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: ))''
Cost of Construction: $ J ► `-t� � b • 00
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
O NER/LESSEE:
CONTRACTOR:
NameGary Picklesimer
Address:250 Shinn Rd
City. Fort Pierce State: _
Zip Code: 34945 Fax:
Phone No.772-486-0914
Name:Adam Sampson
Company:Southpaw Plumbing & Metering Services, LLG
Address:1458 SW Bartell Ave
City: Port St. Lucie State:
Zip Code: 34953 Fax: 772-324-6531
Phone No772-486-0914
E-Mail info 9 southpawwater. com
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County LicenseCFC1428285
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
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 conflicts with an applicable applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners 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 vour Notice of Commencement.
Signature of Owner/ Le ee/Contractor as Agent for Owner
STATE OF FLORIDA (!
COUNTY OF ) f
Sworn to (or affirmed) and subscribed before me of. —Physical Presence or Online Notarization
this L-1 day l )L by
J/ of �_r d--,Y r.`"_. . 20J./ 14Gt Z,_e
Name of person making statement.
'
Personally Known . k OR Produced Identification
' ' atian Prod Type of Iden uced
e of N P u b I - ate of Florida)INotary Public State of Florida
Commission tt HH 152444r<
My Comm. Ex ires Se 29, 2025Commission No. (Seal)"""Bonded
through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev J/ 20/ 21