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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rr
Date: 8/30/21 Permit Number:
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Building Permit Application St.Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT.APPLICATION FOR: Electric Panel Change out
PROPOSED IMPROVEMENT LOCATION:
Address: 2515 KERR ST, FORT PIERCE
Property Tax ID#: 2419-601-0019-000-3 Lot No.
Site Plan Name: Block No.
Project Name: Electric
J-DETAILLD-DESC RIPTIO&OF.WORK: �.
Remove old electric panel and install new one
New Electrical Meter X Second Electrical Meter (Affidavit required)
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CONSTRUCTIO&I.N FOR MATION:
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: 1,251 Sq. Ft.of First Floor: 1,261
Cost of Construction:$ 2200.00 Utilities: _Sewer _Septic Building Height:
OWNERAESSEE.: = CONTRACTOR:.
Name Dorothy Barron Name: Bovell Richards
Address: 5102 Avienda AVE, Company: Revolution Electric Inc
City: Fort Pierce State: FL Address: 15818 64t1i_Place N
Zip Code: 34946 Fax: City: Loxahatchee State: FL
Phone No.772-267-5550 E- Zip Code: 33470 Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail re_VQLL,tk-t0 U1gt(!Cy"�3&
from the Owner listed above) State or County License EC13006764
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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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ✓[L Not Applicable MORTGAGE COMPANY: Q Not Applicable
Name: Name: _
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: 1I
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FEE SIMPLE TITLE HOLDER: ✓�Not Applicable BONDING COMPANY: allot Applicable
Name: Name:
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Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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 conflicts with any.applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners 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
wit r or an�ittarne -beftf-ecorrimencing work or recording our Notice of Commencement.
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Sign of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF St-L-ueie
Sworn to(or affirmed)and subscribed before me of R1 Physical Presence or=Online Notarization
this 30tl-day of August ,20 21 by
Name of person making statement.
Personal) Known F✓ OR Produced Identification 1�rvrr,,
Y z�•U,m�: CLARELE D,HAY
ES
Type of Identification fro u ed t;r-,�w 'A ,� woiar
Yp �. y;Pubpc•state of FI rlda
corflMy Lomm lsslon q GG 191986
C /t/�i l� 1 • find Expires Mar 14,2022
(Signature of Notary Public-State of for a) n
Commission No. (Seal)
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