HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
i
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: 2012 NW ROYAL FERN CT
Legal Description: HARBOUR RIDGE -PLAT 6- ROYAL FERNVILLAGE UNIT 6 (MAP 44126N) (OR 2660-2261)
Property Tax ID #: 4425-605-0020-000-0 Lot No.
Site Plan Name: Royal Fern Block No.
Project Name: Chabot
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Repair damaged 200 amp meter can per FPL request.
CONSTRUCTION INFORMATION:
Additional work toa nertormed under
this permit— check
all
that appy:
HVAC
Gas Tank
Gas Piping
Shutters
Windows/Doors
RIElectric ❑ Plumbing
Sprinklers
Generator
❑� Roof Roof pitch
Total Sq. Ft of Construction: 3051
5 Ft. of First Floor:
Cost of Construction: $ 950
Utilities:
Sewer
lo
L_J
Septic
Building Height:
OWNERAESSEE: CONTRACTOR:
Name J Richard Chabot Name: Donald B Green
Address: 2012 NW Royal Fern Ct Company: Don Green Electric
City: Palm City State: FL Address: 1305 W 1 st Street
Zip Code: 34990 Fax: City: Fort Pierce State: FL
Phone No, Zip Code: 34982 Fax,
E -Mail: Phone No. 772-418-5937
Fill in fee simple Title Holder on next page ( if different E -Mail: dongreenelectric@gmail.com
from the Owner listed above) State or County License: EC13007447
I
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 MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x. Not Applicable BONDING COMPANY: x Not Applicable
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.
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 your Notice of Commencement.
D, e)
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA !
COUNTY OF
The forgoing instrument was acknowledged before me
this'day of Y '� 20 1by
1=I
{N a ofac owledging
{Sig ure f Notary Public- State of lorida )
Personally Known OR Produced Identification
Type of Identification Produces
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF fj
The forgoing instrument was acknowledged before me
this qday of 20 i by
{Nam of person knowle ging )
{Signa re f otary Public -State of F o cJa
Personally Known OR Produced Identification
Type of Identification Produced
JOY CHRISTINE CUPtLANU
�,g.Y AUB
Commission No. a `n MISSION #FF948042 Commission No. �xY py®�� J �` �}STINE COP€LAND
EXPI ES: JAN 05, 2020 may) ChR15510N #FF948042
`l Bonded through 1 Sl Slate Insurance l �[ jd� �— EXPIRES: JAN 05, 2020
GvuLrsG Giiuuyri ia� �d�e msuiaoice
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS