HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �,- (0 0 Permit Number: 9-001— (7)1 WD
Building Permit ApplicattOM �o
Planning and Development Services V
Building and Code Regulation Division 3<
2300 Virginia Avenue,Fort Pierce FL 34982 ''
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMITTYPE: ELECTRICAL
PROPOSED IMPROVEMENT LOCATION:
Address: 1253 NETTLES BLVD
Property Tax ID#: 4502-501-1440-000-4 Lot No. 1253'
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
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
WIElectric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
255, i
Cost of Construction:$ Utilities: _Sewer _Septic Building Height: ii
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OWNER/LESSEE: CONTRACTOR:
Name NETTLES 1253 LLC Name:EDWARD D.FLACK !I
Address:378 SW North Shore BLVD Company:KILOWATT ELECTRIC COMPANY U
Port St Lucie FL 1700 NW 22ND AVE
City: State:_ Address:
Zip Code: 34986-17.72 Fax: City: POMPANO BEACH State:FL
Phone No. Zip Code: 33069 Fax: 954-975-9946,1
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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SUPPLEMENTAL CONSTRUCTiON.'.LIEN LAW INFORMATION;
DESIGNER/ENGINEER: x_Not Applicable l MORTGAGE COMPANY: x Not Applicable
Name:wA Name:wA
Address:NIA Address: NIA
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: wA
City:wA 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 Counter 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 T- 1l JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTTO OBTAIN FINANCING, CONSULT
WITR YOU NDER 012 AN AIIQMFY REFQRE RECORDING YOUR NO F COMM NCEMENT.-
/4/
Signati&df Owner/Lessee/Contractor as Agent for Owner Signaudz1b6f 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 48 day of JANUARY .20 zu by this 1s day of JANUARY 20 20 by
Name of person making statement. Name of person making tatement.
Personally Known P o �Ced d ti i 'o Personally Known 7 OR Produced Identification
Type of Identification NSine m fiorida Type of Identification
Produced ; Produced
tp2mea +�. WbryPubkcSts4�offbri
"rw w EVires aiial=2s r Diane E Oeoghouse
._ Mr commWion GG 257,7811
iia w� Expires 0Uo1�?A22 :i
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 SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19