HomeMy WebLinkAboutPERMIT APPLICATION03242022.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 - -Qy - 2e 2-2- Permit Number:
Building Permit Application
Planning and Development Services XX
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PRQ1P9SEQ IMPROVEMENT LOCATION:
Address: 360 Nettles Blvd Jensen Beach Florida 34957
Property Tax ID #:
Site Plan Name: _
Project Name:
4502-501-0546-000-0
Mraz AC CHANGEOUT
Mraz 3 TON PACKAGE UNIT
AC Change out like for like 3 ton package unit I q
k
Lot No._
Block No.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION':
Additional work to be performed under this permit — check all that apply:
XMechanical _ 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: $ 5692.00 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Nettles 360 LLC
Name: JOHN BROWNING
Address: 171 BELLHAVEN DR
Company: JBAC AND ELECTRICAL INC
City: WOODSTOCK State: GA
Zip Code: 30188 Fax:
Phone No7707782543 E-
Address: 2090 NW FEDERAL HWY
City: STUART State: FL
Zip Code: 34994 Fax:
Phone No 773-634-6315
Mail:-nmraz@att.net
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ibackimberlj�(a�gmail.com
State or County License CAC1816319
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City: _
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 the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 attornev before commencing work or recording vour Notice of Commencement.
Signa re of on ractor - - Owner Builder as applicable
STATE OF FLORI
i U4. �thu�ftl/
COUNTY OF i'�e_
Sworn to (or affirmed) and subscribed before me of Physical Presence
or Online Notarization
this ?_ff day of IY ae t-1 - , 20 22.. by
Name of person making statement.
Personally Known XX OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No.I�y 2123`�s I IMBERLYA.FERRELL
(Seal)
Notary
Public
10. State
of Florida
Commit HH212345
Tres 1/2/2026
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21