HomeMy WebLinkAbout1123 Nettles BlvdAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
ICOUNTY
s
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: Electric
PROPOSED IMPROVEMENT LOCATION:
Address: 1123 NETTLES BLVD
Property Tax ID #: 4502-501-1310-000-4
Site Plan Name: 1123 Nettles
Project Name: 1123 Nettles
DETAILED DESCRIPTION OF WORK:
like for like service change
CONSTRUCTION INFORMATION:
Permit Number:
Building Permit Application
Commercial Residential X
Additional work to be performed under this permit —check all that apply:
Mechanical — Gas Tank — Gas Piping — Shutters
_ Electric — Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 1600
Sprinklers Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
— Roof Pitch
Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
NameThomas Van Loan
Address:316 Banbury RD
City: Massapequa NY State:
Zip Code: 11758 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If values of ennctriertinn is Q717M .. ner- +nmr
CONTRACTOR:
Name: Donald B Green
Company: Don Green Electric LLC
Address: 1305 W 1st Street
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No772-418-5739
E-Mail dongreenelectric@grnaii.com
State or County License EC13007447
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR
CTION LIEN LAW INFORMATION:
Not App
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
r-it%r•
Zip: Phone:_
MORTGAGE COMPANY:
Name:
Address:
ritu-
Zip; Phone:
Not Applicable BONDING COMPANY:
Name:_
Address-
City:_
Zip:
Phone:
Applicable
State:
of Applicable
to obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made
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, wails, 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 THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
.,�•.-0% Ir' vnfm mATIfF nF C_AMMENCEMENT."
WIT YOUR LENDER OR AN AT 1 URNEi BEFORE RE--nv.""—��—
Signature of Contractor/License Holder
Signature of Owner/ Le5see/Contraetot as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrumenp wa ackn wledged before me
. this day of , 20
The fo ing instr c n wledged before me
this day of z0 Y
Name of person making statement.
Name of person making statement.
Personally Know OR Produced [dent ication
Personally Known OR Produced Identification
Type of Identifi ation
YP
Ty of Identification
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Pro cad
(S' atu 'of Notary bli&Vto O land
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(SignatdNotary tang C4937752
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Commission No. Sores
a
Commisso. 04 ON
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19