HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 4909 ELM AVE
Residential xxx
Legal Description: WHITE CITY BLK 24 LOTS 1 AND 2 -LESS S 65 FT- AND S 15 FT VAC CHARLOTTA ST ADJ ON N (0.15 AC) (OR 1269-2796)
Property Tax ID #: 3404-501-0117-000-0
Site Plan Name: Dunn
Project Name: Dunn
Setbacks Front _ _ Back:
Right Side: Left Side:
Lot No. 1 and 2
Block No. 24
Repairing damage on house behind service panel. Need to remove panel in order for them to make
repairs. Need to have FPL shut off power and then reconnect when work is complete
CONSTRUCTION INFORMATION:
Additional work to be nertormed under
this permit — check
I]Gas
all t1lat apply:
Q
HVAC Gas Tank
Piping
_ Shutters
Windows/Doors
ZElectric ❑ Plumbing
Sprinklers
1:1 Generator
E]Roof Roof pitch
Total Sq. Ft of Construction:
950
S. Ft. of First Floor: 1488
O
Height:
Cost of Construction: $
Utilities:
Sewer Septic
Building
OWNER/LESSEE:
CONTRACTOR:
Name Susan F Bridges
Name: Donald B Green
Address: PO Box 12604
Company: Don Green Electric LLC
City: Fort Pierce, State: _
Zip Code: 34982 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@gmaii.com
State or County License: EC13007447
If value of construction is $2500 or more, a RKORDtD Notice of Lommencement is requireu.
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 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
commencing work or recording vour Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �,q STATE OF FLORIDA V 4
COUNTY OF i I i1< (� COUNTY OF I` p -m fy
The forgoing instrum_Wt was acknowledged before me
this (day of itG 20fb by
(NarA of pe
de
Commission No.
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The forgoing instrument was acknowledged before me
this () day of 20 by
of pefson ac4nowledgi
Public- State of t1orida ) I (SAnat*'of Notary Public-_�;fatElof Florida)
-\_ ` OR Produced Identification
on Produced
(Seal)
OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
JDY C:H,;pC -:r,..._, ..LAND JOY CH
My ComtaS`. ,uv *t +948042°
:' kxn MY COMMISSION #Ff948042
Revised 07/15/2014 EXPIRES: JAN 0-5. -'?0210 EXPIRES: JAN 05, 2020
Bonded through ist Sszre snsoranr:e °i Bonded through 1st State Insurance
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