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HomeMy WebLinkAboutApplication for Electrical PermitMASTER PERMIT: PERMIT NUMBER• 1. 2. 3. ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE FORT PIERCE, FL 34962-5652 561-462-1553 APPLICATION FOR ELECTRICAL PERMIT SEE REVERSE SIDE FOR INSTRUCTIONS DATE: LOCATION/SITE ADDRESS: DESCRIPTION OF PROJECT OR WORK ACTIVITY: /j ee) se c0 I1ct- 4. OWNERS INFORMATIOT 5. CONTRACTORS INFORMATION Name: ('S y D ^ D Q i��r FL REG/CERT #: Address: / k &'je COUNTY CERT #: City:}P-P(GQ State: Business Name: % , 0 �-2tA) Elydi! , G .1-► - Phone: (SGI ✓ SFG� - 92 Z Zip: 6. VALUE OF CONSTRUCTION: $ C 024 FEES DUE: RECEIPT: 08 NOTE: A SEPARATE PERMIT IS REQUIRED FOR A TEMPORARY POLE. OWNER'S AFFIDAVIT: / \nV 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 NAMES�'� STATE OF FLORIDA, COUNTY OF I • LICE C . 1 SIGNATURE OF QUALIFIER/OWNER SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF , 20_, BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODI,.CED AS IDENTIFICATION. SIGNATURE OF NOTARY NOTARY PUBLIC TITLE TYPE OR PRINT NAME OF NOTARY (seal) 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 structural 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:' ............... ................................ 2. PARCEL ID --NUMBER: ......................................................... 3. DESCRIPTION OF PROJECTOR WORK ACTIVITY........ 4. OWNERS INFORMATION: ................................................. 5. CONTRACTORS INFORMATION: .................................... 6. VALUE OF CONSTRUCTION: ........................................... ;Indicate the street address, or general location, of the property on which the building activity is taking place. Indicate the Property Tax Identification Number for the property on which the building activity is taking place. Briefly describe the building activity under permit application. Indicate the name and address of the owner of the property on which the electrical repair or replacement is taking'place. i Indicate the State of Florida (if applicable) and St. Lucie County contractors registration numbers, and the name of the business doing the electrical 'work'. 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 (561) 462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday.