HomeMy WebLinkAboutCarroll J. Montgomery - Building Permit Application SLCY
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/27/2017 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
Address: 6504 DORIS DR.
Legal Description: LAKEWOOD PARK UNIT 813
Property Tax ID #: 1301-610-0091-000-4
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
* LIKE FOR LIKE 200AMP PANEL REPLACEMENT
* INSTALLATION OF INTERLOCK SYSTEM FOR PORTABLE GENERATOR
Lot No. 21
Block No. 5
E1HVAC
❑✓ Electric
Plumbing Sprinklers
Total Sq. Ft of Construction: —
Cost of Construction: $ 2400.00
L _I Shutters
FGenerator
Sq. Ft. of First Floor: _
Utilities: Sewer Septic
Name CARROLL J. MONTGOMERY
Address: 6504 DORIS DRIVE
City: FORT PIERCE State: FL
Zip Code: 34951 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Roof pitch
Building Height:
Name: GEORGE M. HAND
Company: MY ELECTRICIAN
Address: 750 NW ENTERPRISE DRIVE
City: PORT ST.LUCIE State: FL
Zip Code: 34986 Fax:
Phone No. 772-878-5123
E -Mail: alopez@mirandacompanies.com
State or County License: EC130033398
it value of construction is �z5uu or more, a RECORDED Notice of Commencement is required.
Name: _
Address:
City: —
Zip:
Applicable
State:
Phone:
FEE SIMPLE TITLE HOLDER: i Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: rNot Applicable
Name:
Address:
City:
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 1 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.
s
ignature of owner/ Lessee/Agent*nuref Contractor/license Holder
STATE OF FLORID q STATE OF FLORIgA
COUNTY OF��--} -�_y('1� COUNTY OF : �
The forgoing instrument was acknowledged before me
this day of 20 LLLby
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The forgoing instrument was acknowledged before me
this _ day of 20 jby
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(Name of per cknowl gin
SUPERVISOR
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REVIEW
REVIEW
REVIEW
REVIEW
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Personally Known Produced Identificati `� .iZ '"%;
Personally Known '� OR Produced Identification
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Type of Identification Produced
Type of Identification Produced91
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INITIALS
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS