HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s
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: 3200 S 7th ST L-x5r, i r
Legal Description: See attached
Property Tax ID #. 2427-601-0060-000-0
Site Plan Name. Windsong Motile Village
Project Name: Windsong Mobile Village
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Lot No. V
Block No.
Right Side: Left Side:
Connect existing 200 AMP service to home
CONSTRUCTION INFORMATION:
Additional wor to e e orme under
OHVAC ID Gas Tank
R]Electric 0 Plumbing
tnis permit —ci
❑Gas Piping
0 Sprinklers
Total Sq. Ft of Construction: 4*5la
Cost of Construction: $ 1500
OWNER/LESSEE:
Name Windsong owner LLC
( 0T_ 1 04
apply:
Shutters Windows/Doors
Generator Roof Roof pitch
S Ft. of First Floor: _
Utilities:OSewer Septic
Address: 1750 S Telegraph Rd #106
City: Bloomfield Hills State: MI
Zip Code: 48302 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: Donald B Green
Company: Don Green Electric LLC
Address: 1305 W 1st Street
City: Fort Pierce
Zip Code: 34982 Fax:
Phone No. 772-418-5739
E-Mail: dongreenelectric@grnail.com
State or County License: EC13007447
If value° of cortstruction I� S a`v'n t C t€i i a ! r.�?-rt r--'`_ _-
State: FIL
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:
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 recordhag your Notice of Commencement.
Signature of Owner/ Lessee/Contractor a gent for Owner
Signature of Contractor/License Ho der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF MARTIN
COUNTY OF MARTIN
Th rgoing instrument was acknowledged before me
thi "tiay -2�
The forgoing inst u ent was acknowledged b fore me
day
of�6s by
this*h of. r7, 20 r
_..L Y
DONALD B GREEN
DONALD B GREEN
Name of person making statement
Name of person making statement
Personally Known X OR Produce Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Pr ced
Produ _
(Sig tur of Notary Public- Sta of lori a)
(Signa a of Notary Pub " - State of Florida j
Commission No. rp 4
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REVIEWS
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PLANS
VEGETATION
SEA TURTLE
ROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
RE IEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17