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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: , • 0�.�1• `�1� Permit Number: -Z-LY) s Building Permit Application 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: L. 77 7 PROPC)SED IMPRO /ENIENT LOCA110N - Address: 108 NETTLES BLVD Property Tax ID#: 4502-501-0294-000-8 Lot No.108 Site Plan Name: Block No. Project Name: DETAiLE© DESCRiPT1t�N OE WdRIC a Install a new 20 amp 120 volt receptacle in new customer supplied enclosure plus/minus 5ft.from the existing power supply G©NSTRUCTIQN INFQFtMATION ,* ,�� _y' 9 ,` 3 411 Additional work to be performed under this permit-check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors IzElectric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ 255 Utilities: —Sewer _Septic Building Height: OWNSRf LESSEE r �' CQNTRACTQRk N' Name Black Oak Investments LLC Name:EDWARD D. FLACK Address:6534 SW Clay SW AVE Company:KILOWATT ELECTRIC COMPANY City: Grand Rapids State: MI Address:1700 NW 22ND AVE Zip Code: 49548-7832 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. Sal'J,PPLEMEi TA �N 11,111 N L EN' W 1,111FORMAT N: :i _ i :' 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 COMMENCEMENT MUST BE RECORDED AND POSTED ON jAEI JOB SITE BEFORE THE FIRST INSPECTION. IF YOU IINTW TO OBTAIN FINANCING, CONSULT WITH YOU ER 9A AN AITDRNEXBEFQRE 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 maki ngtatement. Personally Known P o c d ti is 'o Personally Known Produced Identification Type of Identification Type of Identification �t►r Notary Pubkic Stats of Florida Produced , Gtr tine Produced My Commission GG 287788 Notary Pubfio State of Flark la o►w Expires 0110112023 r ;� Diane E Gadinghouse + My Commission GG 2877 Expires 0110112023 ('Signature of No 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 ev.2/7/19