HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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91To L�1 19
O
RPI' Building Permit Application
Planning and Development Services v'
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: SERVICE CHANGE
Address: 2145 NETTLES BLVD
Property Tax ID #: 4502-501-0148-000-0 Lot No. -
Site Plan Name: NETTLES ISLAND MC, A CONDOSECnON I PARCEL 145 AND PRO•RATA SHARE IN COMMON ELEMENTS Block No.
Project Name: DON DRENTH- SERVICE CHANGE
;DETAILED DE5C
ON OF WORK:
SERVICE CHANGE DUE TO DAMAGE ON EXISTING PANEL
New Electrical Meter Second Electrical Meter
CONSTRJCTIO +OR�iAT?ON --- —�-
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _ Windows/Doors _ Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction�:� Sq. Ft. of First Floor:
Cost of Construction: $ (9 (1 y ). Utilities: _ Sewer _ Septic Building Height:
OUVNE(fLESSEE --
IONTRACTOR:
Name -i)01N TD V-J,7- N T R
Name: MOT-IYTi M '_24 (Q Y PLSC& 3
Address: 21445 NEiTI F5 B�I_I()
Company: (
City: bEff °-R Stater
Address: —I91C) eg1J �� V�6,S hp—
,
City; Oil)fi1ZT State: l
ZipCode: �q!50- Fax: 22-2-/�/n-Iia2-g
PhoneNo. /� - /�=%(jy
q
Zip Code: I��i 9 C) + Fax: -7 -%IO .rg2r]
E-Mail: I.)6D127-1JT-H P ow1 )&T
Phone No -17Q - 910 - (9 1 66
Fill in fee simple Title Holder on next page ( if different
E-Mail fU V_nA )LER SC�NPT N>✓�tPr-RTS • BI
State or County License _T:;0, ! 360 SL1F
from the Owner listed above)
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
EN
LIEN LAW !.�,,�-CRMA i 1011N:
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: 'Not Applicable
Address:
City: State:
Zip: Phone: /
FEE SIMPLE TITLE HOLDER: /Not Applicable I BONDING COMPANY:
AaaresS: I Address:
City: City:_
Zip: Phone: Zip: —
Phone:
Applicable
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 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 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.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commenrine work nr rprnrriino vnur Nntirp of rnmmanramant
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature Contractor/License Hol er
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFhI Krz-1 I k)
COUNTY OF kk T I N
Sw-off to (or affirmed) and subscribed before me of
V
Swoln to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
V Physical Presence or Online Notarization
this 20 day of (kYr—1 L 2020 by
this ZQ day of Apo 41 2020 by
- P(A!rT NB v)
M R- -Twee 'tom-M)L p-psw
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification V
Type of Identification
Type of Identification
Produced TLL/�S f it- C- URF
Produced L /[t Fr)6
(SignatM of Notary Public- Stafeof Florida)
(Signatur Notary Public- State offlorida )
Commission NoQ:63L5LI �J (2 (Seal)
Commission No.a� 35QCi I $ (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
TAV,OR M JONES
Notary Pubic - State o' r:oricd
TAYLOR M JONES
Notary Public - State of Florida
Committing R G(. RSaa IR
Bonded through Nation: Notary Assr., I Borcec thrp.gh Nation: Notary ASSn.
My Notes
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