HomeMy WebLinkAboutApplication for Electrical Permit,-MASTER E'ER PERMIT:
PERMIT NUMBERQ-i O k =
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2.
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LOCATION/SITE ADDRESS:
PARCEL ID NUMBER:
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1553
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APPLICATION FOR
ELECTRICAL PERMIT
SEE REVERSE SIDE FOR INSTRUCTIONS
DATE: /2—/O -0o
7 / D V. S . �4 kJY 1 Al.Ay"6 E'
03- Zz.y - 000S"- o
DESCRIPTION OF PROJECT OR WORK ACTIVITY: L/6617-5 Fv/2 o,cc lWfA415E S16-41
4.
OWNERS INFORMATION
5. CONTRACTORS INFORMATION
Name:
4 AIAI R 1/ 6- S IAJ6-
FL REG/CERT #: C
Address: -750 /V. E'. 5 Enos e-y
ECH gi V/,•
COUNTY CERT#: Yav
City:
aCNSEn/ Q 6-14 e H State:
EL OR/Z) 4
Business Name: 14e0/V/4L 1> /? S C 4/11 /7 T
Phone:
SCSI Z25 3s57 Zip:
3'/457
6.
VALUE OF CONSTRUCTION:
$ Z,, o0o.
FEES DUE: 7 7•
NOTE: A SEPARATE PERMIT IS REQUIRED FOR A TEMPORARY POLE.
OWNER'S AFFIDAVIT:
RECEIPT:O 113 3 1 1 8
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.
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PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF Se-M,'-VO L e-
SWORN=.AP!@ StiBS6l�l EFORE ME THIS /0 DAY OF I)CC 20 O0 BYI?otiAtD P. S�%/4/r✓7-
WHO S PERSONALLY KNOWN TOM R WHO HAS PRODUCED AS IDENTIFICATION.
DAVID CHOLAK
D At//D C No c A`( NOTARY PUBLIC - STATE OF FLORIDA
SIGNATURE OF i4RY # ET ORCP NT NAME OF NOTARY COMMISS1019a )rea3m
NOTARY PUBLIC TITLE �' 32 COMMISSION NUMBER BONDEDTTHEXPRU�s�,naft l OTARy,
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: ..............................................
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3. DESCRIPTION OF PROJECTOR WORK ACTIVITY.......
4. OWNERS INFORMATION: .................................................
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.
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.
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gcallin• 462-1261.