HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r7 �y�
Date: - ���� 2
Permit Number: 1M 1 0-11
Building Permit ApplicaEm
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROF05EQ111/IPROVEM;ENT LC)CATIQN ..
Address: 7 NETTLES BLVD
Property Tax ID#: 4502-501-0193-000-0 Lot No.7
Site Plan Name: Block No.
Project Name:
DETAILEQ`DESCRIPT(O�l QF WC}'RK
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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
.
CQNSTRUT(C}N.l'NFtRMAT
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Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Olectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 255 Utilities: —Sewer _Septic Building Height:
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;OWNER/LEs�SEE CQNTRACTCIR , A
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Name Dejan Stojic Name:EDWARD D.FLACK
Address:7132 Mariana CT Company:KILOWATT ELECTRIC COMPANY
City: Boca Raton State: FL Address:1700 NW 22ND AVE
Zip Code: 33433-6938 Fax: City: POMPANO BEACH State.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.
SUPPLEMENTAL C�NSTR�UCTIONLEN�L`AUI°('INIF MATI`QN `"�
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: x Not Applicable
Name:N/A Name:NIA
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:NIA 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 thepermit 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 YA JOB SITE BEFORE THE FIRST INSPECTION. IF YOU IINTW TO OBTAIN FINANCING, CONSULT
WITH YOU ER AN ATT RE RECORDING YOUR NO F CO NCEMENT."
Signat r f Owner/Lessee/Contractor as Agent for Owner Signat of 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 20 20 by
Name of person making statement. Name of person making tatement.
Personally Known P o c d ti is 'o Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced rN Nomt PEUGcstateFlorida Produced
MWY ComrrtisGsion CaCi 28 88 y Notary Public State of Florida
a w Expires 01/0112023 ;4 `� My Co E GarGnGG 2S7
My My Commission GG 2877
?o,wj Expires 01/0112023
( ignature of Notary Public-State of Florida) (Signature of Notary Public-St r
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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