HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
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 xx
PERMIT APPLICATION FOR: Electrical � {{
PROPOSED IMPROVEMENT LOCATION:
Address: 6506 PALOMAR PKWY
Legal Description: LAKEP,tOOD PARK-UNIT 12-A-BLK 173-A W 16 50 FT OF S 158.47 FT OF LOT 12 AND E63.71 FT OF_OT 13(~1311314)(OR 36332559)
Property Tax ID#: 1301-615-0137-0004 Lot No.12
Site Plan Name: Palomar Block No. 173A
Project Name: Palomar
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
re energize
CONSTRUCTION INFORMATION:
Additional war toe e orme under this permit—check a1f app y:
HVAC Gas Tank F]Gas Piping _Shutters Q Windows/Doors
Electric F-1 Plumbing 7 Sprinklers Generator El Roof Roof pitch
Total Sq. Ft of Construction: 2400 S�of First Floor:
Cast of Construction:S 350 Utilities: Sewer F]Septic Building Height:
OWNER//LESSEE: -�� j CONTRACTOR:
Name / ��' //�,� /1 ,7/G^ Name: Donald B Green
Address: D / / t? ' Company: Don Green Electric LLC
City: tate: FL Address: 1305 W 1St Street
Zip Code: 34997 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34982 Fax:
j E-Mail: Phone No. 772-418-5739
Fill in fee simple Title Holder on next page(if different E-Mail: dongreenelectric(pgmaii.com
from the Owner listed above) State or County License: EC 13007447_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
' SUPPLEMENTAL CONSTR TION LIEN LAW INFORMATION:
CDESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address: i
City: State: City: State:
Zip: Phone Zip: � Phone: v ��
FEE SIMPLE TITLE HOLDER: Nat Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: i
Zip:` Phone: I 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 County makes no representation that is granting a permit will authorize thepermit 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,
accessary 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
co_mmeDcing work or recording our Notice of Commencement.
Signature of Owner/Lessee Tactor as Agent for Owner Signature of Contractor/License er -
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF ( 6�d-.._._ f COUNTY OF________,--__
The for oing Inst( ent was acknowledge before me The f r oing instrument was acknowledged before me
this day of 2 by this day of - ( 20 by
3?_ � /l,
Name of persdCyry�aking statement Name of person making statement
Personally Known I.,1J OR Produced Identification Personally Known =,�C, OR Produced Identification
Type of Ident fication q ; Type of Identification
Prod, ed I Produce _
(Sig ur f Notary Publi Ida (Signat
cµrreme,°
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�Vyi 4 )o2JOY ON#FF9480422Commission No. NE CQCommission oras t!rc ;�i�SiBarded through 1stS
EXPIRES:JAN 05 77,
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REVIEWS 1 FRONT f ZONING SUPERVISOR , PLANS j VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I REVIEW i REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17