HomeMy WebLinkAboutpermit applicationALL APPLICABTE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Plonning and Development Services
Building ond Code Regulotion Division
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (7721 462-1553 Fax: (772) 462-1578 Commercial Residential xx
PERMIT APPLICATION FOR: Etectricat
PROPOSED I MPROVEMENT LOCATION:
Address: 6506 PALOMAR PKWY
Legal Description:LAKEWOOD PARK-UNIT 12-A- BLK 173-A W 16.50 FT OF S 158.47 FT OF LOT 12 AND E 63.71 FT OF LOT 13(MAp 13/13N) (OR 3639-2559)
Property Tax lD #: 1301-615-0137-000-4 Lot No.12
Site plan Name: Palomar 91o.L Po. 173A
Project Name: Palomar
Setbacks Front Back:Right side:Left Side;
DETAILED DESCRIPTION OF WORK:
re energize
lditional \
Eruo.
permrt -applv:
2r,".,,,.tr_
Gas Tank
Plumbing
trtrlGas Piping
lsprint<ters tr-
Shutters
Generator
tr
u_
Windows/Doors
Total Sq. Ft of constru.llon' 24oo So. Ft. of First Floor:
Utilities: l_l r"*", E t"Cost of Construction: $ 350
CONSTRUCTION I NFORMATION :
lf value of construction is $2SOO or more, a RECORDED Notice of Commencement is required.
OWNER/LESSEE:CONTRACTOR:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Donald B Green
Don Green Electric LLC
Address: 1305 W 1St Street
P hone 111o. 7 7 241 8-57 39
E_Mail: dongreenelectric@gmail.com
State or County License: Ec13oo7$7
RI
su PPLE M ENTAL CONSTRLil{ION Lt EN LAW I N FORMATT ON :\
DESIGNER/ENGINEER: -1_-NotApplicable
Name:
Address:
City:State:
zip:Phone
MORTGAGE COMPANY: / :! ruot Applicable
Name:
Address:
City:State:
zip:Phone:
FEE SIMPLE TITLE HOLDER: ," \Not Applicable
Name:
Addres s:
City:
zip:Phone:
BONDING COMPANY: / NotApplicable
Name:
Addr ess:
City:
zip:Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countv makes no representation that is granting a permit will authorize the permit holder to build the subiect structure
which is in conflict with anv dpplicable Home Owners As5oclation rules, bvlaws or and covenants that mav restrict 6r prohibit such
structure. Please consult with liour Home Owners Association and review'your deed for any restrictions uihich may apply.
ln consideration of the granting of this requested permit, ldo hereby agree that lwill, 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. lf you intend to obtain financing, consult with lender or an attorney before
ing work or Notice of Commencement.
Signature of Owner/ Lessee,
STATE OF FTORIDA
COUNTY OF
Name of persdg,ryraking statement '
Personally Known ./ OR Produced ldentification
Signatdre of Contractor/License
STATE OF FLORIDA
COUNW OF
Name of pergoq making statement
Personallv Known '-K' OR Produced ldentification.:-----i-Type of ldentification
*ffiil;",T.,ki:::,*,
,'{{ffigii'.,1,::fl1
B,d:I'J[::;'iiir":::,-;;
REVIEWS VEGETATION
REVIEW
SEA TURTLE
REVIEW
DATE
COMPLETED
Rev.8/2/17
The
this
ALL APPLICABLE INFO MUST BE COMPTETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
Building Permit Application
Planning and Development Services
Building ond Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (7721 452-1553 Fax: (172) 462-1578 Commercial Residential xx
Legal Description:LAKEWOOD PARK-UNIT 12-A- BLK'173-A LOT 12-LESS W 16.50 FT OF S 158.47 FT- (MAP 13/13N) (OR 3639-2559
Property Tax lD #:1301-615-01 36-000-7 Lot No.12
91o.1 11o. 173ASite Plan Name: Palomar
Project Name: Palomar
Setbacks Front_ Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
re energize
ional wor applv:
tr
Z
HVAC
Electric tr
Gas Tank
Plumbing tr
Shutters
Generator
tr
tr_
Windows/Doors
Total Sq. Ft of Construcllon' 24oo So. Ft. of First Floor:
Utilities: l_lr"*", Et"*Cost of Construction; $ 350 Building Height:
PERMIT APPLICATION FOR: Electrical E
PROPOSED IMPROVEM ENT LOCATION:
Address:
,E(
CONSTRUCTION INFORMATION :
lf value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
OWNER/LESSEE:CONTRACTOR:
Don Green Electric LLC
/sr
City:State: FL
phone 11o. 772-418-5739
E_Mail: dongreenelectric@gmail.com
State or County License: Ec13o07447
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
-
Piping
city: 3Tl ),t-€T ' -stIt"' FL
SU PPLE M ENTAL CONSTRUCT]ON Ll EN LAW I N FORMATION :
DESIGNER/ENGINEER: x Not Applicable
Name:
Address:
City:
Zip:.
State:
Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City:State:
7ip:Phone:
FEE StMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
zip:Phone:
BONDING COMPANY: _Not Applicable
Name:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countv makes no reoresentation that is sranting a Dermit will authorize the permit holder to build the subiect structure
which is in conflict with anv a'pplicable Home Owhers AsSociation rules, bvlaws or and covenants that mav restrict <ir prohibit such
structure. Please consult With iour Home Owners Association and review'your deed for any restrictions rr'ihich may apply.
ln consideration of the granting of this requested permit, I do hereby agree that lwill, 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
Signatil6 of Contractor/License
srArE oF FLoRTDA [-.beT ]{\lCOUNTY OF
ffi i5[rr' " ;.'ffEz' n' "*'."iouHero re me
-lroxl*,o A qeae=il
oerson making statement'--n
OR Produced ldentification:--r--
l',ili#;"rthfiW:y,
Bondsd lhr0ug,,l lsl S:drc ilsurance
STATE OF FLORIDA
COUNTY OF
Name of pdrgrn making statement
PersonaIlyKnown--, ORProducedldentification
Type of ldentification
in g instpu4qntw4q acknowledge*hefore me
dav of \)G- .zol1bv
JOTCHRISTINE COPELAND
MY C0Mlg6gtgN #Fre48A12
EXPIRES: JAN 05, 2020
Eonded through I st State lnsurance
SUPERVISOR
REVIEW
VEGETATION
REVIEW
SEA TU RTLE
REVIEW
DATE
COMPLETED
Rev.8/2/17
Citv:
Zip: _
Owner