HomeMy WebLinkAbout06110030 (2)
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
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BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
State of Florida Certification Number (Ifapplicable):
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St. Lucie County Contractor Certification Number:
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(Company NarnelIndividual Name)
have agreed to b·e the
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(Type of Trade )
sub-contractor for !<,A1r/C'1 J.. ·tJ-VV/..s 0 'J / - ð "3 0
(Primary Contractor)
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(Project Street Address or Property Tax ID #)
for the project located at
It is understood that, if there is any change of status regarding our participation with the
above mentioned project, I will immediately advise the Bl}ilding and Zoning Department
of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV
N·o. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
ORI-GINAL SIGNA T·URES ARE IŒQUloRE'Ð
Business Name:
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pRINT NAME DME /
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Address:
City/State/Zip:
, Phone:
OFFICE USE ONLY:
PERMIT #
ISSUE DATE
MASTER PERMIT: () ~ / I ¿J0 0 é)
PERMIT NUMBER:
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
APPLICATION FOR
ELECTRICAL PERMIT
SEE REVERSE SIDE FOR INSTRUCTIONS
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1.
LOCA TION/SITE ADDRESS:
DA TE:
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IdrT ST: LLJc/~ FL c3 1983
2.
PARCEL ID NUMBER:
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3.
DESCRIPTION OF PROJECT OR .WORK ACTIVITY:
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4.
OWNERS INFORMATION
5.
CONTRACTORS INFORMATION
FL REG/CERT #:
COUNTY CERT #:
Name:
Address:
City :
State:
Business Name:
Zip:
Phone:
6.
VALUE OF CONSTRUCTION: $ / ~ .) 300. ~
FEES DUE:
RECEIPT:
NOTE: A SEPARATE PERMIT IS REQUIRED FOR A TEMPORARY POLE.
OWNER'S AFFIDAVIT:
I certify that all of the information contained in this application is correct and that all work will be done in compliance with
all applicable laws regulating construction and zoning.
PRINT QUALIFIERS/OWNERS NAME
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NOTICE TO OWNER:
STATE OF FLORIDA, COUNTY OF .
SWORN TO AND SUBSCRIBED BEFORE ME THIS 5-"'*bAY OF (fin, ,20D7, BY I1.u;d A. Btvjb
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCE~ AS IDENTIFICATION.
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TYPE OR P~INT NAME OF NO'¡:' RY S.·~ ~t!~. ~ ~
NOTARY PUBLIC ITLE DD'" ~I£, COMMISSION NUMBER ~ ~~( ~...~é?~~.: ~
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YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN Y~~p. ING31t¥J. t: -f!<ift
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT ~. .'kliN~.~,,"~N
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. ~/" r/l; S;;IT·O~~~ ,,~
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Jun 11 07 11 :35a
p.1
untitled
June 11, 2007
RE: permit #0611-0030
594 SE Hidden River Dr
PSL, FL 34983
Attn: Doris
per our conversation today, ~his ;s notificaLion that we are cnanging our electrical
contractor from
EAL to CEI.
CEI wi" be bringing in their sub contractor le~ter with original signatures to
complete this changeM
please call me if you need any additional information.
Tha~~JYou, ~~'l
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Lorra1 ne Lew1 S
772 579 1200 cell
RECEIVED
JUN 11 2007
PERM 11", J ;~u
Sf. Lucie Count~'. F'
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page 1
X-.;Á~ a~~~~.,
Code Compliance Division
2300 Virginia Avenue
Ft. Pierce, FL 34982
Phone: (772) 462-1553 Fax: (772) 462-2522
http://stlucieco.gov/ce
Building
Receipt
Date: 11 June 2007 Receipt #: 0000054873
Job Address: 594 HIDDEN RIVER DR 'ennit Number: SLC- 0611-0030
Received By: dpelton Amount: $50.00
Paid With: MC =redit Card Number: XXXXXXXXXXXX4695
Check Number:
Paid By: LORRAINE W LEWIS Sign:
:;ç- Á~ a,~~:~",.
Code Compliance Division
2300 Virginia Avenue
Ft. Pierce, FL 34982
Phone: (772) 462-1553 Fax: (772) 462-2522
http://stlucieco.gov/ce
Building
Receipt
Date: 11 June 2007 Receipt #: 0000054874
Job Address: 594 HIDDEN RIVER DR 'ermit Number: SLC- 0611-0030
Received By: dpelton Amount: $2.00
Paid With: MC :=redit Card Number: XXXXXXXXXXXX4695
Check Number:
Paid By: LORRAINE W LEWIS Sign: