HomeMy WebLinkAbout320 Nettles Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
v <c - 3
Building pp Permit A lic' on
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: pct�i p \10-5
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: "s< Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 2- 2 00 00
Windows/Doors — Pond
Sq. Ft. of First Floor: —
Utilities: —Sewer _ Septic
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name as - a�
Name: WiMOM mik—
Address`�,�G
I n,�,,11,,LL
Company: Og6L � +1,n1�(fMinwiM l`b(I1SItUC�l�lr�
City: ' ��� � State:`;'
Zip Code: 'JN3l'S7A Fax:
Phone No.
Address: L '9i CS., I� �Qi � Ale --
City: i-y-- T1-C rC_e_ State:-E�-
Zip Code: t (9 Fax: r�
Phone No ��-` Lb - p2-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail --h h man 0 CL++ - i1C4-
State or County License 2 O 12 6
If value of construction is z5uu or more, a KtLUKUtU ryouce or %.ommencemenL a 1e4u11cu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: ✓ Not Applicable
Name: 44S Name:
Address• (14113l t Address:
City: 0K, r:nCLO State: �- L-_ City: State:
Zip: �293 [l Phone '7,?)4- W7P Zip Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip. Phone:_
Not Applicable BONDING COMPANY: ✓Not Applicable
Name:_
Address:
City:
Zip:.
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to ao the worK ana ins>:anauun dJ 11WILCIMU.
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 structuin re. with
w with applicable
Owners Association iandrreviewyyour deed for any estrict that
which ma oa prohibit such
Y 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
I ucie Countv and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work
or recording our Notice or l,ommencernenL.
Sign re of Ow r/ L ssee/Contractor as Agent for Owner
Signa 0e of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF�_�,
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
_, Physical Presence or Online Notarization
this `� day of 1by
this may of :—.L. 2020 by
\2020
Name of person making statement.
Name of person making statement.
Personally Known ----OR Produced Identification
Personally Known ' '� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
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