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Building Permit Application
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:2.3. 2V Permit Number: ©oL © 00z � - D RECEIVED o - Building Permit Applicati n FEB 0 4 2020 Planning and Development Services Building and Code Regulation Division ST. Lucie County, Permitting 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMITTYPE: PROPOSED IMPROVEMENT LO ATION: Address: 1386 NETTLES BLVD Property Tax ID#: 4502-501-1573-000-5 Lot No.1386 Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: Install a new 20 amp 120 volt receptacle in new customer supplied enclosure plus/minus 5ft.from the existing power supply CONSTRUCTION INFORMATION: Additional work to be performed under this permit–check all that apply: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Wklectric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ 255 Utilities: —Sewer —Septic Building Height: OWNERAESSEE: CONTRACTOR: Name J Murray Shaft Name:EDWARD D.FLACK Address:24536 Overseas HWY PO Box 420488 Company:KILOWATT ELECTRIC COMPANY City: Summerland Key State: FL. Address: 1700 NW 22ND AVE Zip Code: 33042-2846 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 CONSTRUCTION LIEN LAW INFORMATION DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: x Not Applicable Name:wA Name:wA Address:NIA Address: wA City: State: City: wA State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable Name:wA Name:wA Address:wA Address: NIA City:wA City:wA Zip: Phone: Zip: Phone: OWNER/CONTRACTOR AFFIDVIIT: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 jAE,JOB SITE BEFORE THE FIRST INSPECTION. IF YOU IINTW TO OBTAIN FINANCING, CONSULT WITH YOU ER OR AN ATT_QRNEXSEEORE RECORDING YOUR NO FCO CEMENT." Signat r f Owner/Lessee/Contractor as Agent for Owner Slgnat of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF eaowaao COUNTY OF BitowAw The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 16 day of J"uARY 202o by this7s day of JAWAR 2020 by Name of person making statement. Name of person mak70R tatement. Personally Known P o c d d ti i Yo Personally Known Produced Identification Type of Identification Type of Identification Produced `'`v� N0 'P"terunou Produced My� , n Zgrygm No"12e4io ft*of Fbi Expires 0710112023 I' Diane 9 My Gamnlz pn0 efthom o,w Egkn 0IM12M (13ignature of Notary Public-State of Florida) (Signature of Notary Public-St n 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.211119