HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED M)'-rm
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Date: U- Ca(Dag Permit Number:
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. W, - I __ 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 X
PERMITTYPE: ELECTRICAL
PROPOSED IMPROVEMENT LOCATION:
Address: 1130 NETTLES BLVD
Property Tax ID#: 4502-501-1317-000-3 Lot No.1130
Site Plan Name: Block No.
Project Name:
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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
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CONSTRUCTION INFORMATION: 3"
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Zklectric _Plumbing _Sprinklers _Generator _Roof Pitch
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Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 255 Utilities: —Sewer —Septic Building Height:
' II
OWNER/LESSEE: CONTRACTOR:
Name
Timothy E Shields(LF EST) Name:EDWARD D.FLACK
Address:9621 Hera Ct Company:KILOWATT ELECTRIC COMPANY
City: Fort Wayne State: IN Address:1700 NW 22ND AVE
Zip Code: 46825 Fax: City: POMPANO BEACH State:FIL
Phone No. Zip Code: 33069 Fax: 954-975-9946
E-Mail: Phone No 954-975-8200
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Fill in fee simple Title Holder on next page if different E-Mail EDDIEFLACK aG�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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SUPPLEMENTAL.GONSTRUCTIDN L(EN LAW ib." r
DESIGNER/ENGINEER: x—Not Applicable MORTGAGE COMPANY: a x Not Applicable
Name:NA Name:wA
Address:wA Address: WA j
City: State: City: NIA State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x Not Applicable
Name:wA
Name,NIA
Address:NIA Address: NIA
City:NIA City:wA
Zip: Phone: Zip: Phone:
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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 Countv 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 FAR-URI: 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 THE)JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INT_W TO OBTAIN FINANCING, CONSULT
WITH YOU ,E DER'OR AN ATTORNEY-BEFORE RECORDING YOUR NO F CO CEMENT."
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Signat r f Owner/Lessee/Contractor as Agent for Owner Signat of Contractor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF eRowARo COUNTY OF mowAw
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me j
this 16 day of JANUARY 20 zn by this 7s day of JANuARY 20 20 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
Produced 'r P"btic °0f Produced
Garliouse
My Cotltrtr;<,sio11 �Brlde R� NMwy Pubft Std of F'ri
'gyp, Expires 01/01=23 r Diane E a8f6ngtoA6
My COMWssim OO
ry.,,at'� 1'upirei avalrmz3
( ignature 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
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COMPLETED j
Rev. 2/7/19
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