HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION 1-0 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 El
PROPOSED IMPROVEMENT LOCATION:
Address: 1275 Nettles Blvd, Jensen Beach, FL 349.57
Legal Description: Nettles Island Inc, a Condo -Section II Parcel 1275 anc pro rata share in common elements (OR 1012-485)
Property Tax ID #: 4502-501-1462-000-4 1275
Site Plan dame: Lot No.
Project Name:Block No..
Setbacks Front Back: Right Side: Left Side:
UE I AILED DESCRIPTION OF WORK:
Remove and replace existing RV power pedestal.
CONSTRUCTION INFORMATION:
itiona war to fi
r orme un ert ispermit—c e
HVAC Gas Tank []Gas Piping
EElectric D Plumbing OSprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1,000.00
OWNER/LESSEE:
Name Harold E. Wulff
Shutters Q Windows/Doors
Generator ❑ Roof Roof pitch
Sq. Ft. c f First Floor: _
Utilities:Sewer DSeptic
Address: 5986 Adamants Dr.
City: Colorado Springs State: CO
Zip Code: 80924 Fax:
Phone No.
E -Mail:
Fill in fee simple Titre Holder on next page ( if different
from the Owner listed above)
Building Height:
CONTRACTOR:
Name: Michael Dale Ault
Company: Ault Brothers, Inc. Electrical Contractor
Address:
City, State: FL.
Zip Code: 34992 Fax: 772-283-0321
Phone 6Vo. 772-283-5520
E -Mail: aultbros@yahoo.com
State or County License: ECO001693
If value of construction is $2SQp or more, a RECORDED Notice of Commencement is required.
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F
iN—r Y
L Oi R ! B A
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 El
PROPOSED IMPROVEMENT LOCATION:
Address: 1275 Nettles Blvd, Jensen Beach, FL 349.57
Legal Description: Nettles Island Inc, a Condo -Section II Parcel 1275 anc pro rata share in common elements (OR 1012-485)
Property Tax ID #: 4502-501-1462-000-4 1275
Site Plan dame: Lot No.
Project Name:Block No..
Setbacks Front Back: Right Side: Left Side:
UE I AILED DESCRIPTION OF WORK:
Remove and replace existing RV power pedestal.
CONSTRUCTION INFORMATION:
itiona war to fi
r orme un ert ispermit—c e
HVAC Gas Tank []Gas Piping
EElectric D Plumbing OSprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1,000.00
OWNER/LESSEE:
Name Harold E. Wulff
Shutters Q Windows/Doors
Generator ❑ Roof Roof pitch
Sq. Ft. c f First Floor: _
Utilities:Sewer DSeptic
Address: 5986 Adamants Dr.
City: Colorado Springs State: CO
Zip Code: 80924 Fax:
Phone No.
E -Mail:
Fill in fee simple Titre Holder on next page ( if different
from the Owner listed above)
Building Height:
CONTRACTOR:
Name: Michael Dale Ault
Company: Ault Brothers, Inc. Electrical Contractor
Address:
City, State: FL.
Zip Code: 34992 Fax: 772-283-0321
Phone 6Vo. 772-283-5520
E -Mail: aultbros@yahoo.com
State or County License: ECO001693
If value of construction is $2SQp or more, a RECORDED Notice of Commencement is required.
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 :)f 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 our Notice of Commencement. '
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA f % STATE OF FLORIDA
COUNTY OF (.(CI COUNTY OF
The forWing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this � day of , 20� by this -c_ day of 20 f�`'by
A i. I— — I ,f a1 F A n I a,
Name of personking statement
.paPersonally Known OR Produced Id
Type o Identification
Produced „
(Signature of Notary Public- State of Florida )
Commission No. ;r g715'60
Name of person aking statement
Personall_ Y Kno�w_n OR Produced Idf
Type of Identification
Produced
(Sign�iture of Notary Public- State of Florida )
Commission No. a5&Q