HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED No
Date: ��" Permit Number:
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.. J�� 21 2020
Building Permit Applic tion
Planning and Development Services ST. Lucie County, P rmitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT L®CAT!{30 � .� '`
Address: 642 NETTLES BLVD
Property Tax ID#: 4502-501-0828-000-1 Lot No.642
Site Plan Name: Block No.
Project Name:
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Install a new 20 amp 120 volt receptacle in new customer supplied enclosure plus/minus 5ft.from the existing power supply
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Additional work to be performed under this permit—check all that apply:
—Me_phanical _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:
C)WN-E,: ECONTRA
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Name Gloria Myers Name:EDWARD D. FLACK
Address:10701 S Ocean DR, Unit Lot 905 Company:KILOWATT ELECTRIC COMPANY
City: Jensen Beach State: FL Address:1700 NW 22ND AVE
Zip Code: 34957-2640 Fax: City: POMPANO BEACH State.FL
Phone No.860-334-4996 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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WN, FIRM
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name:N/A Name:wA
Address:NIA 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:NIA 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.
Inconsideration 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 �JOtBEFORE THE FIRST INSPECTION. IF YOU N O IN FINANCING, CONSULT
WITH YOU 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 B--
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 16 day of.JANUARY zQ 20 by this 16 day of JANUARY ZQ 20 by
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Name of person making statement. Name of person making statement.
Personally Known OR Produceden I ICa ion ers n ---
- Type of Identification Type of Identification
Produced '��-� L- Produced
Miry Put#!e Stft of FloriOa
(Signature of Nota D WiN ign ture of Notary Public- ° 01ro nOx+ ��
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Commission No °� 416,2020 Commission No.
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REVIEWS RONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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