HomeMy WebLinkAboutSLC Permit App.Talley Residence.All APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3/10121 Permit Number:
O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 114770range Av Ext
Property Tax lD #: 2309-700-0001-000-0
Site Plan Name: Campbell Road Shop )PB 91-5) Parcel 1 (1 AC - 43,560 SF)
Project Name:
DETAILED DESCRIPTION OF WORK:
Per request of FPL; replace meter can "like for like materials"
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
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ _200.00
Generator
Lot No._
Block No.
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name John G Talley
Name: Joseph E Herndon, Sr
Address: PO Box 1132
Company: Joe's Electric of St Lucie Cnty., Inc.
City: Fort Pierce State: FL
Zip Code: 34954 Fax:
Phone No. -?7A -PP?- r219-1;
Address: 1206 Bell Avenue
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No 772 216-0830
_
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail joes@usa.com
State or County License EC13007203
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,5500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Nat Applicable
Name:
MORTGAGE COMPANY:
Name:
S Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
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
w en r or an attorney before commencing work or recording our Notice of Commencement.
r
Signature Own / Lessee/Contractor as Agent for Owner
Signat of Co ract .License older
STA OF FLORIDA
S TE OF FLORIDA
C NTY OF St Lucie
OUNTY OF St Lucie
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
X Physical Presence or Online Notarization
this in day of March 2020 by
this 10 day of March 2020 by
Joseph E Herndon, Sr.
Joseph E Herndon, Sr
Name of person making statement.
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
l�
(Signature a Notary
(Signature of-44otaryqW10 i s
� X 01. Notary Public Stale of Florida
uy� rry Notary Pubic to of FIor10a
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Randolph AAcDaniei
Commission No. RandolprbWoaniel
Commission No. y Co.r.4 CO352355
My Gommiaaa�m GG 352355
Expires W0T12023
) ar Expires 09107/2023
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Rev. 516120