HomeMy WebLinkAboutScan_0465All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
•
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: Electrical
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential x
Address: 1347 Nettles Blvd, Jensen Beach, FL 34957
Property Tax ID #: 4502-501-1534-000-0
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Install electric for new power pedestal
I CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit -check all that s pply:
Mechanical _ Gas Tank —Gas Piping —Shutters Windows/Doors
)(- Electric Plumbing _ Sprinklers — Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 2,000.00 Utilities: —Sewer —Septic Building Height:
Pitch
OWNERAESSEE:
CONTRACTOR:
NameKen & Lois Miller
Name: Michael Dale Ault
Address:1347 Nettles Blvd
Company:Ault Bros, Inc. Electrical Contractor
City: Jensen Beach State:
Zip Code: 34957 Fax:
Phone No.
Address: PO Box 1528
City: Port Salerno State: FL
Zip Code: 34992 Fax:
Phone No 772-283-5520
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above]
E-Mail aultbros@yahoo.com
State or County License EC0001693
If VdWe Oi GonStrucuon is ->LSUu or more, a Kt:LVKUtV Notice or 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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
-yvL,-C4�1)
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF �-Y
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of _�C3y !+_c,�5-� 20by
this day of _fJ..v =.�h 20by
Name of person making statement.
Name of person making statement. ^^
Personally Known X OR Produced Identification
Personally Known `N OR Produced Identification
Type of entification
Type of :dentification
ProdiAced
Produced
(Signature of Notary P lic-�5 e o o i a
otary Public State of Florida
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Diana L Ma on
Commission No. <. MyCor GG316460
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Commission No. e
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REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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