HomeMy WebLinkAboutBuildling Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
COL! NT Y
F L O- R 1 U %
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1105 KINGSWOOD LN
Legal Description: DRIFTWOOD MANOR -SECTION TWO- LOT11 (0.52 AC) (OR 1013-271)
Property Tax iD #: 3404-807-0011-000-6
Site Plan Name: Mayberry
Project Name: Mayberry
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
replace existing 200 amp panel like for like
CONSTRUCTION INFORMATION:
AdaitionalworKtooeberformed un Pr
OHVAC
ZElectric
—c
L_J Gas Tank UGas Piping
El Plumbing Sprinklers
Total Sq. Ft of Construction: 1820
Cost of Construction: $ 1796
OWNER/LESSEE:
iJI M2
Lot No.
Block No.
Shutters Q Windows/Doors
Generator 0 Roof Roof pitch
S Ft. of First Floor: 1820
Utilities: Sewel� Septic
Name R David Mayberry
Address: 1105 Kingswood Ln
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: Donald 8 Green
Building Height:
Company: Don Green Electric LLC
Address: 1305 W 1st Street
City: Fort Fierce
Zip Code: 34982 Fax:
Phone No. 772-418-5739
E-Mail: dongreenelectric@gmail.com
State or County License: EC13007447
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
State: EL
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: x 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:
Address: Address:
City: City:
Zip: Phone: Zip: Phone,
L.
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 re -cording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as �gentforOwner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MARTIN COUNTY OF MARTIN
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Name of person making statement
Personally Known X OR Produced identification
TypeAf Identification
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State of
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COUNTER I REVIEW
DATE
RECEIVED
DATE
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Rev. 8/2/17
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Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
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