HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
Building Permit Application
Planning and oevelopment Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-5578
PERMIT TYPE: Electric
PROPOSED INPROVEMENT LOCATION:
Address: 956 Nettles Blvd, Jensen Beach, FL
Property Tax ID #: 4502-501-1143-000-2
Site Plan Name:
Project Name:
EETAILED DESCRIPTION OF WORK:
Install new power pedstal to replace existing -
CONSTRUCTION INFORM
Commercial
Residential
Additional work to be performed under this permit - check all that apply:
5hutters
Mechanical
Gas Tank f Gas Piping
Sprinklers Generator
X Electric _ Plumbing f p
Total Sq.
Ft of Construction: Sq. Ft. of 'First Floor: —
Cost of Construction: $ 1,000.00 Utilities: _Sewer _Septic
OWNER/LESSEE:
Name Richard Ingersoll
Address: 956 Nrttl!- Blvd
City: Jensen Brach State: FI
Zip Code: 34957 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.-�
Block No. —
—Windows/Doors
Roof Pitch
Building Height: .
CONTRACTOR:
Name: Michael Dale Ault
Company:Ault Bros, Inc Electrical Contractor
Address: PO Box 1528
City: Port Salerno None State: FL
Zip Code: 34992 'Fax:
Phone No772-283-5520
E-Mailaultbrosaa yahoo.com
State or County License EC0001 693
if value of construction is $2500 or more, a RECORDED Not1Ce of Commencement Is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 apermit 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.
INA
Signature of Owner] Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OFM
The forgoing instru ent was acknowledged before me
this- day of 20a by
P11 X CACtel h3je L, P
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State
..'�}}�,r* Notary Public State of
Commission No. G-gsyV1 �►Ve4l)
Thomas E HiII
MY Commission GG 21
Expires 02/Ol> 023
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of ontracto /License older
STATE OF FLORIDA
COUNTY OF
The for Ding instrument was acknowledged before me
this, day of 6nyMg!nr 20 by
A,( -,I M/
A -i; 7�-
Name of person making statement.
ersonally Known OR Produced Identification
Type o I entifica ion
Produced
of Notary Public- State
an No.u�ifp11 +Peary Public State Df
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My Commission GG 2
a w Expirss 02/09/2023
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