HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
S
•
• R
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Fierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 390 Nettles Blvd
Propertyiax 1D #: 4502-501-0576-000-9
Site Plan Name: Brown
Project Name: Brown
Permit Number:
Building Permit Application
Commercial Residential X
DETAILED DESCRIPTION OF WORK:
Remove existing service and replace with new 200 AMP meter main combo
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical — Gas Tank —Gas Piping — Shutters Windows/Doors
_ Electric _ Plumbing — Sprinklers
Total Sq. Ft of Construction: NIA
Cost of Construction: $ 2100
_ Generator _ Roof
Sq. Ft. of First Floor: 1428
Utilities: —Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name James M Brown
Name. Donald B Green
Company: Don Green Electric
Address: 123 E Division Rd
City. Valparaiso, IN State: _
Address: 1305 W 1 st Street
Zip Code: 46383 Fax:
City: Fort Pierce State: FL
Phone No.
Zip Code: 34982 Fax:
Phone No772-418-5739
E-Mail:
E-Mail dongreenelectric@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License EC13007447
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR ION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: of Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: � of Applicable
Name:
Address:
City:
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
ITH*D ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
OUR LENDIM OW AN ATTORN" BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF._-
COUNTY OF
The f r Ding instrument was acknowledgedbefore me
The forgoing instrum nt was acknowledged before me
�
this day of _ 20 by
this 1 ,day of . _ _, 2p/by
Name of person making statement.
Name of person making statement.
Personally Know OR Produced Identification
Personally Known OR Produced Identification
Ty e of Identification
Type of Identification
Pr
ProdOwd
e IS L
( na of r' Notary tMWW#FF948M
[sign ure Notawti-jg xpires
' My Commission Exres
}anuar 5, 2020
Commission No. ianuvmAi020
Commission No. Sea
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev_ 217119