HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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 X
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION.
Address: oziu ttircn UK Fort Pierce, FL 34982
Legal Description: INDIAN RIVER ESTATES -UNIT 07- BLK 51 LOT 13 (MAP 34102S) (OR 4010-866)
Property Tax ID #: 3402-608-0407-000-2
Site Plan Name: Birch Drive
Project Name: Piller
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Service change 150 AMP like for like
Install interlock kit for generator
Right Side: Left Side:
Lot No. 13
Block No. 51
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CONSTRUCTION INFORMATION:
CONTRACTOR:
Name James Piller
Name: Donald B Green
orme un e
A itiona wor to e nej r
t is permit— check
❑Gas
a
appy:
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No. 772-418-5739
E -Mail: dongreenelectric@gmail.com
HVAC I J Gas Tank
ZElectric 0 Plumbing
Piping
Sprinklers
_ Shutters
1:1
a Windows/Doors
F]
Generator
Roof Roof pitch
Total Sq. Ft of Construction: 1358
Sq. Ft. of First Floor:
Cost of Construction: $ 1170
Utilities:
Sewer
Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name James Piller
Name: Donald B Green
Address: 5210 Birch DR
Company: Don Green Electric LLC
City: Fort Pierce State:FL
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: dongreenelectric@gmail.com
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: EC13007447
111W,C, a nr%-unucv imouce or commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 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.
to
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF MARTIN
The forgoing instrument was acknowledged before me
this 18th day of October , 201A. by
DONALD B GREEN
Name of person making statement
Personally Known X OR Produced Identifica n
Type of Identification
Pr ced
(Sign tur of Notary Public- State of FI rida )
HRISTINE COPELAND
Commission No. ' "`°�� MISSION #FF948E42
EXPIRES: JAN 05, 2020
0� Bonded through 1st State Insurance
REVIEWS I FRONTZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
STATE OF FLORIDA
COUNTY OF MARTIN
The forgoing instrument was acknowledged before me
this 18th day of October , 20'/A by
DONALD B GREEN
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
�I
(Sigrildre rtary Public- State of Florida )
Commission No. "�d� JOIf;IINSPNECOPELAND
'A MY COMMISSION #FF948E42
a ►.f EXPIRES; JAN 05, 2020
SUPERVISORI PLANS I VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW