HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01/06/2017
COUNTY �'
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential J
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
(`PROPOSED IMPRCOVEMENTLOGAT)ON:
Address: 495 PELICAN SHOAL PL G-20 - FORT PIERCE, FL 34982
Legal Description: TROPICAL ISLES (OR 2786-2163) UNIT G-20 (OR 2834-2463).
Property Tax ID p: 3410-508-0173-000-0 Lot No.
Site Plan Name: _ Block No.
Project Name: REPIPE AND WATER HEATER REPLACEMENT
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: J
WHOLE HOUSE SUPPLY REPIPE AND REPLACEMENT OF FAILED ELECTRIC WATER HEATER
TANK WITH AO SMITH ELECTRIC WATER HEATER LOCATED IN EXTERIOR ACCESS PANEL OF
MANUFACTURED HOME.
CONSTRUCTION INFORMATION..„'";
AdId�itIional work to be er(orm ed on der th is permit — check all apply:
IIO�IHVAC Gas Tank DGas Piping Shutters Windows/Doors
lel Electric ❑✓_Plumbing Sprinklers Generator I (Roof Roofpitch
Total Sq. Ft of Construction: 5Ft. of First Floor:
Cost of Construction: $ 5800.00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
Name David L 8 Nancy L, ROGERS
Address: 495 Pelican Shoal PI G-20
City: Fort Pierce State: FL
Zip Code: 34982 Fax: We
Phone No. 775466-8715
E -Mail: n/a
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
(CONTRACTOR:
Name: Robert W LUDLUM
Company: Benjamin Franklin Plumbing
Address: 1631 SW South Macedo Blvd
City: Port St. Lucie State: FL
Zip Code: 34984 Fax: 772-871-9069
Phone No. 772-871-9494
E -Mail: permitsgbenfranklinplumber.com
State or County License: CFC1426801
If value of construction Is $2500 or more, a RECORDED Notice of .ommencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY
Name:
Name:
Address:
Address:
City:
State: City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable BONDING COMPANY:
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
Not Applicable
State:
_Not Applicable
St Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which ism 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 roams and accessory uses to another non-residential use
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 jobsite
before the first inspection. if yep intend to obtain financing, consult with lender ora attorney before
commepyi a l or re S your Notice of Comme Tcement.
S
Signature of vner/Lessee/Contractor as Agent for wn Signa ure ofWorHalder
STATE OF FLORIDA & lac,¢. STATE OF FLORIDA \— r -T -t -C c_e�
COUNTY OF COUNTYOF _
The ffp. �ying InstjuW enc was acknowledged before me The forgoing ins ment was acknowledged before me
thisg day of 2017 by thivItL day of .•,,, .20 17 by
la tbat J
(Name of pe on acknowledging) (Name of person nowledging ging) )
i
1U Aa✓tSE,t,W }
(Sign atute of Not 7 P/y lic-Sta e o Florida) (Signatui"e of Notes Public- State of Flonda I
Personally Known OR Produced identification_ Personally Known I/ OR Produced Identification
Type of Identification Produced. _ - _- Tjoofdontification Produced
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