HomeMy WebLinkAboutCowlesALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/07/2017
Permit Number:
J
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: 1115 S BROCKSMITH RD
Legal Description: 17 35 39 N 331.18 FT OF NE 1/4 OF NE 1/4 OF NW 1/4- LESS CANAL R/W- (4.75 AC - 206,910 SF) (OR 3923-249)
Property Tax ID #: 2317-211-0001-000-4
Site Plan Name: BROCKSMITH
Project Name: COWLES
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
IDETAILED DESCRIPTION OF WORK: I
Install interlock kit for portable generator
CONSTRUCTION INFORMATION:
Additional work toa nertormed under this permit— check a appy:
HVAC Gas Tank []Gas Piping Shutters ❑ Windows/Doors
ZElectric ❑ Plumbing Sprinklers El Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: 3502
Cost of Construction: $ 750.00
S Ft. of First Floor:
Utilities:Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Victoria Cowles
Name: Donald B Green
Address: 1115 S Brocksmith Rd
Company: Don Green Electric
City: Fort Pierce State: FL
Zip Code: 34945 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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Martin
The forkoing instrument was acknowledged before me
this � day of 't—� 20 Y� by
(Nape of person
of Notary Public- State of Florida )
PerYonaq Known X OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
��- 'P"d, '_'_ s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Martin
The forgoing instrument was acknowledged before me
this 7th day of November 20 1 by
'g '/=9 er�-7E�^J
(Name oRperson acknowledging )
(Signatorje of NV tary Public- State of Florida
Personally Knout X OR Produced Identification
Type of Identification Produced
JO 5 �TINE COPELAND Commission No.
MY COMMISSION #FF948042
EXPIRES: JAN 05, 2020
J(8"l ISTINE COPELAND
MY COMMISSION #FF948042
EXPIRES: JAN 05, 2020
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