HomeMy WebLinkAboutApplication for Electrical PermitMASTER PERMIT:
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LOCATION/SITE ADDRESS:
PERMIT NUMBER: Z
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
DATE:
PARCEL ID NUMBER: 3 `1I Y S O ) " �9 D 3 - c/o �g
Name:
Address:
City:
Phone:
OR WORK ACTIYITY:
OWNERS INFORMATION%N
LL73�' l
k,r -! ,r Zacl � State: 145�%ll-
Zip:
6. VALUE OF CONSTRUCTION: $ SAC
NOTE: A SEPARATE PERMIT IS REQUIRED FOR A TEMPORARY POLE.
5.
CONTRACTORS INFORMATION
FL REG/CERT #: C'C;rj /, �/-
COUNTY CERT #: 1 D 3 19
Business Name: _ �'0'W �
7;t/c
FEES DUE:
RECEIPT:OI! 33SYlr
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and at a woill be done in co liance with
14 1 all pplica ble la re t;lat�g con�t�ucti nd zoning.
CIO PRINT QUALIFIERS/OWNER NAME GNATURE OF QUALIFIER/O,1`111NER
STATE OF FLORIDA, COUNTY OF V
�l n
` p SWORN TO AND SUBSCRIBED BEFORE ME THIS .DAY OF , 19_, BY
r T� WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED AS IDENTIFICATION.
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY (seal)
NOTARY PUBLIC TITLE COMMISSION NUMBER
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
ST. LUCIE-COUNTY ELECTRICAL PERMIT
INSTRUCTIONS
Please complete all information in the space provided. All information must be Printed (use black or blue ink
only) or Typed.
This application for Electrical Permit to"be used for only those activities that are not otherwise included under
a primary building permit. This application for Electrical. Permit may not be used for any activity that includes
any type or kind of structural alteration. Building activities involving structura'l:`alteration, in addition to the
electrical work, must be permitted through the regular building permit review process. The information to be
provided with this application includes:
1. LOCATION/SITE ADDRESS: ..............................................
Indicate the street address, or general location, of the
property on which the building activity is taking place.
2. PARCEL ID NUMBER: ................... ........................ ............
Indicate the Property Tax Identification Number for the
property on which the building activity is taking place.
3._ <`DESCRIPTION OF PROJECT OR WORKACTIVITY.........
Briefly describe .the building activity under permit
application.
4. OWNERS INFORMATION: ..................................... ..z........, ``
-Indicate the name and address of the owner of the
property on which the electrical repair or replacement is
taking place.
5. CONTRACTORS INFORMATION: ....................................
Indicate the State of Florida (if applicable) and St. Lucie
County contractors registration numbers, and the name
of the business doing the electrical work.
6. VALUE OF CONSTRUCTION: ...........................................
Indicate the total value of the electrical work to take
place. Total cost of construction includes all material
and labor costs associated with the
building/construction activity. The value of construction
is used to determine the amount of permitting fees to be
assessed. St. Lucie County reserves the right to
question and/or modify the indicated value of
construction- if it is demonstrated that the submitted
figures are not consistent with similar types of
construction.
All applications for Electrical Permits are to be submitted to the St. Lucie County Building and Zoning
Department, St. Lucie County Administration Building, 2300 Virginia Avenue, Fort Pierce, FL 34982. All
applications for Electrical Permits must be complete and filed with the .Department no later 4:30 P.'M. each
business day. No applications will be accepted for processing after 4:30 P.M. For assistance; in
completing this application, please contact the St. Lucie County Building and Zoning Department, at (569)
462-1553, during regular, office hours (8:00 AM - 5:00 PM), Monday through Friday.
Following the issuance of this Electrical Permit, the scheduling of all required inspections may be made by
calling (561) 462-1261.
3 u y SLCCDV FORM NO: 006-05
CAD