HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/11/22 Permit Number:
ST. LUCIE
COU N-T�Y -.
F L "'OWt
Rit" D A
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: GAS WATER HEATER
_. ,:. 4,. ..._ ,+ rK'`;. 7 ^ . :.:. j.. °.' , ... ;�' � K.<I .. uF o � �-� -5 r i � ✓ .<LH fi � � . �;•, � ,l K,:
PROPOSED IMPROVEMENT L�CATLON.w x
Address: 3104 ANDERSON DR.
Property Tax ID #: 1432-807-009-000-0
Site Plan Name:
Project Name:
CHANGE OUT 40 GALLON GAS WATER HEATER.
New Electrical Meter Second Electrical Meter
Lot No.
Block No.
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: _
Cost of Construction: $ 500.00
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height. -
Name PRICILLA A. KING I Name: CHRIS JOHNSON
Address: 3104 ANDERSON DR.
City: FT. PIERCE State:
Zip Code: 34946 Fax:
Phone No. 772-489-4765
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 I MORTGAGE COMPANY: Not Applicable
Name:
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
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.
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 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 1pnrlpr nr an attnrnpv hpfnrp r_nmmenr_ins= work or rpcordinE vour Notice of Commencement.
Signature of Owner a e/ ontractor as Agent for Owner
Signature of Contractor/License older
STATE OF FLORIDA
STATE OF FLORIDA '
COUNTY OF S�. 4t.4 e/0
COUNTY OF S17 Z-0 r r '.
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
_,eL Physical Presence or Online Notarization
this •- L day of ;TAU- , 202tby
this L day of � [AM . 2021 by
Name of person making statement.
Name of person making statement.,
Personally Known_ OR Produced identification
Personally Known OR Produced Identification
-
Type of Identification
Type of Identification
-Produced
Produced
oe—
(Si nature of Notary P b -c- of lorida L
(Signature of Nota
•NY P• •, MARTiiA A KERR
Commission No. '?�: := Notary Pt(f$ia:al�tate of Florida
'►�Y PL•. MARTHA A KERR
•'� �; ;
Commission No. '��% �• ^' Notary Public - I FEorida
commission N GG 311213
My Comm. Expires Mir 22, 2023
141N\III\
ommission GG 311213
• ,o�:.• My Comm. Expires Mar 22, 2023
Notary Assn.
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DATE
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DATE
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Rev. 5/6/zo