HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: r,� ' in Permit Number:
Building Permit Applicati®
Planning and Development Services Lai
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: CL�L
PROPOSED IMPROVEMENT LOCATION:
Address: 1337 NETTLES BLVD
Property Tax ID#: 4502-501-1524-000-7 Lot No.1337
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
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:
OWNERAESSEE: CONTRACTOR:
Name Charles V Lynch Jr Name:EDWARD D.FLACK
Address: 1133 Nettles Blvd Company:KILOWATT ELECTRIC COMPANY
City: Jensen Beach State: FL Address:1700 NW 22ND AVE
Zip Code: 34957-3386 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 CANSTRuicnowLIEN LAW INF RMATION
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name.WA Name:NIA
Address:NIA Address: NIA
City' State: City: WA State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 6 Not Applicable BONDING COMPANY: x Not Applicable
Name:PVA Name,NIA
Address:NIA Address: NIA
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.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 TAE) JOB SITE BEFORE THE FIRST INSPECTION. IF YOU I TO OBTAIN FINANCING, CONSULT
WITH YOU ER OJR AN ATT EFDRE RECORDING YOUR NRILC
OFCO CEMENT."
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 BRowAm
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 16 day of JANUARY .202 by this 15 day of JANUARY 202D b
— -- y
Name of person making statement. Name of person mak70R
tatement.
Personally Known P o c d d ti ' t•o Personally Known Produced Identification
Type of Identification Type of Identification
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Produced Produced
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('Sign atu re of Notary Public-State of Florida} (Signature of Notary Public-Stft1fn
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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