HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ Permit Number: `�— ��J'i.y
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 a
PROPOSED IMPROVEMENT LOCATION:
..Address:
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 ID#: 1301-615-0136-000-7 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:
Additionalwor to e er orme under this permit—check a appy:
oHVAC Gas Tank Gas Piping Shutters a Windows/Doors
ZElectric 1:1 Plumbing Sprinklers o Generator Roof Roof pitch
Total Sq. Ft of Construction: 2400 5 Ft.of First Floor:
Cost of Construction:$ 350 Utilities:0 Sewer F Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ' C % Name: ;f t� 1 t� f� C`��N t A/
Address: �� / �` � C Company: Dan Green Electric LLC s
City: �`� t _ State: FL Address:; `r L
Zip Code: 34997 Fax: City: 7"ot/ y 1-L'�L-�., State:FL
Phone No. Iy Zip Code: 34982 Fax:
E-Mail:_ i Phone No. 772-418-5739 i
Fill in fee simple Title Holder on next page(if different E-Mail: dongreenelectric@gmaii.com
j from the Owner listed above) 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: 1 Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: ;
Address: Address:
City: State: City: State:
Zip: Phone . Zip: Phone:
FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name: i
Address: Address:
City: City:
Zip: Phone: 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,
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
comrftncing work or recording Your Notice of Commencement.
Si ature of Owner/Lessee—Mt5htracto'r_as4gent for Owner Signature of Contractor/License '
STATE OF FLORIDA STATE OF FLORIDA
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COUNTY OF COUNTY OF
Th omg inst n w s knowledge
efore me The f oing instr ent as acknowiedgpd before me
thi day of 201!by this day of -�E'.., J 20�by
Name ofp making statement Name of person making statement
Personally Known! OR Produced Identification Personally Known�OR Produced Identification
i Type of Identification Type of entification
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EXPIRES.oAN 05,2020 Bonded thraug is..
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REVIEWS FRONTZONING SUPERVISOR PLANS VEGETATION ; SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I --- -
RECEIVED
DATE
I COMPLETED _ I
Rev.8/2/17