HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2. �r G Permit Number:
it
O
® - CD <%
0 �0
Building Permit Application �G�
Planning and Development Services C, o�
Building and Code Regulation Division ?;��� o "
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE: ELECTRICAL
PROPOSED IMPROVEMENT LOCATION:
Address: 1275 NETTLES BLVD
Property Tax ID#: 4502-501-1462-000-4 Lot No. 1275
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
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:
OWNERAESSEE': CONTRACTOR:
Name Harold E Wulff Name:EDWARD D.FLACK
Address:5986 Adamants Dr Company:KILOWATT ELECTRIC COMPANY
City: Colorado Springs State:CO Address:1700 NW 22ND AVE
Zip Code: 80924-4201 Fax: City: POMPANO BEACH State:FL
Phone No. Zip Code: 33069 Fax: 954-975-9946;
E-Mail: i 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.
I
I
SUPPLEMENTAL' CONST RUCTiON;UENiLAW tNFORNfAT(ON
14
DESIGNER/ENGINEER: x—Not Applicable MORTGAGE COMPANY: xNot Applicable
Name:NIA Name:N/A
Address:MA 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:N/A Address: NIA
City:N/A 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 thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an 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 IND
POSTED ON TAE)JOB SITE BEFORE THE FIRST INSPECTION. IF YOU IMTW TO OBTAIN FINANCING, CONSULT
WITH YOUWUNDER OR AN ATIMIRNEX BEEO RE RECORDING YOUR NO F CO CEMENT."
4
Signat r f owner/Lessee/Contractor as Agent for Owner Signat of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF aRowARo COUNTY OF wKmAw
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 16 day of JANuARY. 20 2a by this is day of JANUARY 2020 b
Name of person making statement. Name of person mak70R
tatement.
Personally Known P o c d d ti i t'o Personally Known Produced Identification
Type of Identif cation , Notuy Stals flori�a Type of Identification
Produced Produced
Nh Commissiwi GG 2ff"UI No1��Y Public stm of Fbri
Ezp=01101=23 r ;4Diann Gadhatioum
ry+a a� Esphes o1,o1r2023;�
(Signature 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
eT