HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f'
Date: Permit Number:
RECE VP-0
Building Permit Applicati n FEB o Z✓2
Planning and Development Services ST. Lucie County, Perrnat-q
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 �I
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 1358 NETTLES BLVD
Property Tax ID#. 4502-501-1545-000-0Lot No. 1358
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
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:
OWNER/LESSEE: CONTRACTOR:
Name Gregory J Poole Name:EDWARD D.FLACK
Address:7 MILLIKIN DR Company:KILOWATT ELECTRIC COMPANY
City: STONEY CREEK State: ON Address:1700 NW 22ND AVE
Zip Code: L8E 51-2 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.
5UPPLEMENTALCONSTRUCTION1LIEN LAW INFQRMAT10
DESIGNER/ENGINEER: x�Not Applicable MORTGAGE COMPANY: x Not Applicable
Name.NIA Name:wA
Address:NIA Address: NA
City: State: City: NIA State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: xNot Applicable BONDING COMPANY: x Not Applicable
Name:NIA Name:NIA
Address:wA Address: WA
City:NIA City:wA
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.Lvie County makes no representation that is.granting a permit v�till 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 TOO 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 INTW TO OBTAIN FINANCING, CONSULT
WITH YOUf ER 9JR AN ATT EF9RE RECORDING YOUR NO F CO CEMENT."
Signat r f owner/Lessee/Contractor as Agent for Owner Signah Contractor/License Hoiden
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF eROWARo COUNTY OF aRowAm
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ae day of JANuaRr 20z0 by this 1s day of JANumy .20 ao by
Name of person making statement. Name of person makingstatement.
Personally Known P o c d d ti i do Personalty Known _ OR Produced Identification
Type of identification s Pubes Sm at i�rida Type of identification
Produced � Garfinghouse Produced NrrtsryPub CStiAsatFbri
My commissw dG 7anaa a? Diane E Ge fthhouse
'gyp p E> o,talr�to2'9 t r My Commission Ban
04,
ignature of Notary Public State of Florida} (Signature of Notary Public-St rc
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. 21 9