HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: ELECTRICAL
PROPOSED IMPROVEMENT LOCATION:
Address. 4705 PALEO PINES CIR, FORT PIERCE, FL 34951
PropertyTax ID #: 1312-801-0122-000-1
Site Plan Name: HOLIDAY PINES S/D-PHASE II -B- LOT 319
Project Name:
Residential XX
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK:
REPLACING EXISTING 200 AMP MAIN BREAKER, 40 CIRCUIT INDOOR, BACK TO BACK CHALLENGER PANEL
TO NEW 200 AMP, 40 CIRCUIT INDOOR MAIN BREAKER PANEL. (FOR INSURANCE PURPOSES)
***CHANGE OUT OF PANEL ONLY***
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION;
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: $ 1,763.00 Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NamedOSEPH WRUBLE
Name: CHARLES LOWE
Address:4705 PALED PINES CIR
Company:CHARLES LOWE ELECTRIC, INC.
City: FORT PIERCE, FL State: _
Zip Code: 34951 Fax:
Phone No. 814-771-5730
Address:452 HERNANDO ST, APT A
City: FORT PIERCE State: FL
Zip Code: 34949 Fax:
Phone N0772-332-9668
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail CLoweElectriclnc@AOL.COM
State or County License 20941 / ER#0015111
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 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 attornev before commencing work or recording your Notice of Commgneement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO DA
COUNTY OF 5 �l t [ i sL COUNTY OF � / Lk
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
✓ Physical Presence or Online NotarizationPhysical Prese ce or Online Notarization
this ��ttay of !�e� x%1020 by this %"r'�'day of 12020 by
Name of person making statement.
Personally Known OR Produced Identification ✓`
Type of Identification
ProducedI 26 i rs
Name of person making statement.
Personally Known OR Produced Identification
Type of Ide! 'fication
Produced�C (:���
(Signature of Notary P liar "' a of Fldl�q LYNN JONES
(Signature of Notary Public- Stat fo6�) JESSICA LYNN JONES
?° Notary Public -State of flanda
=? Notary Public State of FI
Commission No. 1 i Comarp}}'5sio # HH 029659
M ComPiloes Oct 15, 2024
Commission No 0 , :?� S ommission HH 0296
Al
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of fl , comm. Expires Oct 15,
r f j 0;1t� ! a Bonded through National Notary Assn.
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R�EVIIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED