HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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 X
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 5706 TANGELO DR
Legal Description: INDIAN RIVER ESTATES -UNIT -09- BLK 77 LOT 6 (MAP 34/11 N) (OR 3628-2050; 3670-1366; 3673-2211)
Property Tax ID #: 3402-610-0191-000-1
Site Plan Name:
Project Name: Tangelo
Setbacks Front Back: _
Right Side: Left Side:
Lot No. 6
Block No. 77
DETAILED DESCRIPTION OF WORK:
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Additional work to beDertormed under this permit — check all apply:
(
HVAC I1 Gas Tank []Gas Piping _ Shutters a Windows/Doors
ZElectric ❑ Plumbing ❑ Sprinklers ❑ Generator E]Roof Roof pitch
Total Sq. Ft of Construction: 1632 Sq. Ft. of First Floor:
Cost of Construction: $ 1900 Utilities:Sewer D Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Lawrence D Smith
Name: Donald B Green
Address: 560 NE Canoe Park Cir
Company: Don Green Electric
City: Port St Lucie State: FL
Zip Code: 34983 Fax:
Phone No.
Address: 1305 W 1st Street
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No. 772-418-5739
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: dongreenelectric@gmail.com
State or County License: EC13007447
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
Name:
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name:
BONDING COMPANY: X Not Applicable
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.
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 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 you intend to obtain financing, consult with lender or an attorney before -
commencing work or recording our Notice of Commencement.
d & V'0� I " A s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Martin
The forgoing instrument was acknowledged before me
th day of �_� , 201--) by
Donald B Green
( me of person acknowledgin
(Si fur of Notary Public- State of orida )
Personally Known xX OR Produced Identification
Type of Identification Produced
Commission No. FF948042
Revised 07/15/2014
JOY CHRISTINE COPELAND
Ml1SWISSION #FF948042
EXPIRES: JAN 05, 2020
Bonded through 1st State Insuranc
STATE OF FLORIDA
COUNTY OF Martin
The for oing instrument was acknowledged before me
this day of • 7e 12 20 I_-� by
Donald B Green
(Na of person acknowledging )
(Sign re Notary Public- State of Florida
Personally Known xx OR Produced Identification
Type of Identification Pro
YI6m
mmiSA9 F ` tw .:;;, (Seal)
MY COMMISSION #FF948
EW Bonded through 1st State Insurance
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