HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/27/21 Permit Number:
sT. LUC1 E
@7@ U NrT-1
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
l
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: WATER HEATER
PROPOSED "IMPROVEMENT"LOCATION:
Address: 3208 JAUNITA AVE.
Property Tax ID #: 1432-807-0046-000-1
Site Plan Name:
Project Name:
CHANGE OUT 40 GALLON GAS WATER HEATER.
New Electrical Meter Second Electrical Meter
CONSTRUCTION fNFORMATION:
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:
OWNER/LESSEE: CONTRACTOR:`,
Name REGINA B. MOORE Name: CHRIS JOHNSON
Address: 3208 JAUNITA AVE
City: FT. PIERCE State:
Zip Code: 34946 Fax:
Phone No. 772-882-1617
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 State: FL
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.
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zi•p: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 commencing work or recording your Notice of Commencement.
Signature of Owner a e/ ontractor as Agent for Owner
Signature of Contractor/License older
STATE OF FLORIDA WSTATE
OF FLORIDA '
COUNTY OF S - - G IV
COUNTY OF ; Z_Gc C 1 �
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
Physical Presence or Online Notarization
this , day of ;;rA_ , 202Lby
this i7l'L_ day of � ra . 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
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(Si nature of Notary P b 'c- t of lorida
(Signature of Notarfts
,.,,..,..
fi�►Y p�''•• MARTHA A KERR
Commission No. ' '.• •.: Notary Pt(fRle*ate of Florida
��Y P& MARTHA A KERR
Commission No. '_�% �• ^ Notary Public - $�1 Florida
F Commission # GG 311213
My Comm. Expires Mai 32, 2023
—Commission GG 311213
..oF;.• My Comm. Expires Mar 22, 2023
I ided through Nation
al Notary ssn.
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