HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' a. �_ Permit Number:
DECEIVE®
Building Permit Applicatio J>�N.21 2020
Planning and Development Services
Building and Code Regulation Division ST. Luci County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
P-4 l�1l?RDUEM EMT
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Address: 245 NETTLES BLVD
Property Tax ID#: 4502-501-0431-000-1 Lot No.245
Site Plan Name: Block No.
Project Name:
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ETAILD DESCRIPTIQ �i1tQtK a � ,�k � v
Install a new 20 amp 120 volt receptacle in new customer supplied enclosure plus/minus 5ft.from the existing power supply
�CQrNSTRUCTIt7N 1NFQRMATI(7N x � `�
Additional work to be performed under this permit-check all that apply:
Me anical Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 255 Utilities: —Sewer _Septic Building Height:
OWNEFtjLESSEE ` t QN` RACTOR
Name Doris M Kronillis Name:EDWARD D. FLACK
Address:9801 S Ocean Dr Lot 245-II Company:KILOWATT ELECTRIC COMPANY
City: Jensen Beach State: FL Address:1700 NW 22ND AVE
Zip Code: 34957-2399 Fax: City: POMPANO BEACH State.FL
Phone No.772-224-6528 Zip Code: 33069 Fax: 954-975-9946
E-Mail: Phone No 954-975-8200
Fill in fee simple Title Holder on next page(if different E-Mail EDDIE-FLACK@KILOWATT-ELECTRIC.COM
from the Owner listed above) State or County License EC13001961
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.
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DESIGNER/ENGINEER: x . Not Applicable MORTGAGE COMPANY: x Not Applicable
Name:N/A Name:N/A
Address:N/A Address: N/A
City: State: City: N/A State:
Zip: Phone Zip: Phone: _
.FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Name:N/A Name:N/A
Address:N/A Address: N/A
City:N/A City:N/A
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 CO NCEMENT MUST BE RECORDED AND
POSTED ON T JO BEFORE THE FIRST INSPECTION. IF YOU N O IN FINANCING, CONSULT
WITH YOU RAN ATTORNEY BEFORE RECORDING YOUR O MMENCEMENT."
Signat r f Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF BROWARD COUNTY OF BROWA-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 16 day of JANUARY ,2020 by this 16 day of JANUARY ,2020 by
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Name of person making statement. Name of person making statement.
ersonally Known Produced en I Ica ion PersoU11
- Type of Identification Type of Identification
Produced '��- L Produced
Notary Public SW9 of Florida OW
Diane F(Signature of Nota IVF-Nsign ture of Notary Public- �y of ' 207788
DANN� 023 'Oa 01!01!2@23
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Commission No �ylGMd 16,2020
IRES:De d Commission No.
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9 :b Bonded TbN Notary
REVIEWS gllRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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