HomeMy WebLinkAboutApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
f
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) 462-1S78 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PC IiPOi=MEnT �ocTl?�N xpx
Address: 11203 S INDIAN RIVER DRIVE
Legal Description: _32 36 41 Part of N139.26ft of S 512.16ft of lot 1 lying_E of Ridge Av Marked Res rued
as in Plat 5 page 31 andrd rw ( 3 )
Property Tax ID #: _ 3532-133-0002-000-6 Lot No. 1
Site Plan Name: Block No,
Project Name: Campbell
Setbacks Front Back: Right Side: Left Side:
Provide and install new 200-amp meter main combo. Provide and install ground rods for grounding
system.
Additional work to be ertormed under this permit— check all apply:
aHVAC F] Gas Tank Gas Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers Generator E]Roof
Total Sq. Ft of Construction: S Ft. L_
of First Floor:
Cost of Construction: $ 2489 Utilities:cn Sewer JSeptic Building Height:
Name. Stanley & Chervil Campbell
Name: JAMES K WILLIAMS
Address: 11203 S INDIAN RIVER DRIVF,
Company: ARLINGTON ELECTRIC
City: FORT PIERCE State: FL
Zip Code: 34982 Fax:
Phone No. 571-217-0650
Address: 3251 SE DIXIE HWY
City: STUART State: FL
zip Code: 34997 Fax: 772-287-2380
Phone No.772-287-1353
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: gregg@arlingtonelectricinc . com
State or County License: EC 13007767
it value of construction is yzsoa or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name
Addre
City:
Zip: _
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
1 certify that no work or Installation has commenced prior to the Issuance of a permit.
Not Applicable
State:
. Not Applicable
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
c:ufmiiviic;ing vvurx ur recoraing your Notice or i.ommencemenL.
_ ig ature of Owner/ Lessee/Agent
S OF FLORIDA
COUNTY OF MARTIN
The forgoing instrument was acknowledged before me
this 10 day of NM ►kv-vim 20`�Lk by
DAMES -K WILLIAMS
(Name of person acknowledging)
<\�y�
(Signature otary Public- State of Florida )
Personally Known X OR Produced Identification
Type of Identification .'
Sig at re of Contractor/License Holder
STA OF FLORIDA
COUNTY OF MARTIN
The forgoing instrument was acknowledged before me
this 10 day of _N N % u-�- . 20 �l by
JAMES K WILLIAMS
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
Personally Known X
Type of IdentificalmW.
iibtt °Ue GREGG H ROBINSON
Commission No, - `�'; Notary Pq§galftate of Florida Commission No.
o= Commission # HH 59076
My Comm. Expires Nov 1, 2024
Revised 07/15/2014
OR Produced Identification
Notary Public • S gf� lorida
—Eommission rt�59 76
My Comm. Expires Nov 1, 2024
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS