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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE ''INFO �MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ® (- 0 4 2,Date: ' �`'1' y►LJ Permit Number: �© $, CRECEIVES2 4 2020 Building Permit Application Permittin Planning and Development Services tY, g Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMITTYPE: >",` .• ,....... 1 .. : ..,f_ . - .,r-_ ti_..r, r 'Csnr..d��p�, ,'L" x^s"v� ... „�_,-� .. �E, „a °° ,«' -' Address: 1181 NETTLES BLVD Property Tax ID#: 4502-501-1368-000-5 Lot No.1181 Site Plan Name: Block No. Project Name: DETAILED [�E�CRIPTION` QF WORK Install a new 20 amp 120 volt receptacle in new customer supplied enclosure plus/minus 5ft.from the existing power supply . $�%{�Y CQNSTRUCTI`CN INFORMTIQNPi Additional work to be performed under this permit–check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric —,Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ 255 Utilities: —Sewer _Septic Building Height: Name R Charles Simpson Name:EDWARD D. FLACK Address:1181 Nettles Blvd Company:KILOWATT ELECTRIC COMPANY City: Jensen Beach State: FL Address:1700 NW 22ND AVE Zip Code: 34957-3392 Fax: City: POMPANO BEACHState:FL Phone No. 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. IQ SSU LEM'ENT�AL CON RUGTI©N LIEN LA lNFORMAT!®N: r �z i>� DESIGNER/ENGINEER: x—Not Applicable MORTGAGE COMPANY: x Not Applicable Name:N/A Name:NIA Address:N/A Address: N/A City: State: City: NIA 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 COMMENCEMENT MUST BE RECORDED AND POSTED ON T JOB SITE BEFORE THE FIRST INSPECTION. IF YOU IINTW TO OBTAIN FINANCING, CONSULT WITH YOURU ER QR AN ATOO NF CO NCEMENT." Signat r f Owner/Lessee/Contractor as Agent for Owner Signatufel6f Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF BROWARD COUNTY OF BROWARD The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 16 day of JANUARY 20 20 by this 16 day of JANUARY 2020 by Name of person making statement. Name of person mak70R tatement. Personally Known P o c d ti is Up Personally Known Produced Identification Type of Identification Type of Identification f Florida Produced N Notary Pu ° Produced Vi MY C mmiwion GO 287788ovP�,, Notary Pubtie State of Flo a Expires 011=2023r '? ; Diane E GarrMhouse r My Commission GG 2677811 Expires0l/01/2023 ('Signature of Notary Public-State of Florida) (Signature of Notary Public-St r Commission No. (Seal) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.2/7/19