HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,), Permit Number:40
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- Building Permit Applicatidrv?`P,
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 X
PERMITTYPE: ELECTRICAL
PROPOSED IMPROVEMENT LOCATION:
Address: 1169 NETTLES BLVD
Property Tax ID#: 4502-501-1356-000-8 Lot No. 1169
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
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WIElectric _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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OWNERAESSEE: CONTRACTOR:
Name Francis Antetomaso Name:EDWARD D.FLACK
Address: 1 Dolphin Dr Company:KILOWATT ELECTRIC COMPANY
City: Massapequa State: NY Address:1700 NW 22ND AVE
Zip Code: 11758 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.
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SUPPLENfENTAL�OtVSTRUCTIDN LIEN LP iNF{�R111iATIDN.
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name:NIA Name:NIA
Address:NIA Address: NA
City State: City: NIA State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Name:NIA Name:NIA
Address:NIA Address: WA
City:NIA City:NIA
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 NUST BE RECORDED AND
POSTED ON T JOB SITE BEFORE THE FIRST INSPECTION. IF YOU i TO OBTAIN FINANCING, CONSULT
WITH YOU ER OR AN AIMOMEY BEFORE RECORDING YOUR NO F CO CEMENT."
Signat r f Owner/Lessee/Contractor as Agent for Owner Signat of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF eRowARO COUNTY OF sRowasa
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 26 day of JANUARY 20_20 by this 1s day of JANttARY 2020 by
Name of person making statement. Name of person making tatement.
Personally Known P o c d d ti i t'o Personally Known '� OR Produced Identification
Type of Identification Type of Identification
�Y Public S'tM Of flotiCa Produced
Produced Garbnahnuse
y Mp Ca slat �D7fQe o k D puWle s of Flori
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F.vims Oval 29 ` r COr+1rN CiC�2FM
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('Signature of Notary 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
RECEIVER
DATE
COMPLETED
ev.
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