HomeMy WebLinkAboutElect Temporary Power Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I O� 12-I Z � Permit Number:
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�LLo L���� � � � �„�` �+�r c�s{y�c hctic
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1�., � � � � Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential '�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: �QJ� W���-���� I1��
Property Tax ID #: 2 S 32 - Sb0 - Oa 2q- _a oa � � Lot No. 1 �
Site Plan Name: li�A'i'�-QbOA.1(o 'j�l.� � �G/k-T' 1<JO O J� �'g -• Q-2 '� Block No.
Project Name: L�A3 Wp�`Q-S0� INA-r-)
DETAILED DESCRIPTION OF WORK:
�[�( j�ntL�� �'Z��-t • 1--t e�f� �("d F�� �-v�.cov �U� of I-
%yV1 PC.�t�x� �F 1-fOD1it C (>iU���2 1�7'C-I�LIC� � Zr��2-O�l¢.
New Electrical Meter � Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
✓Electric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ l 2bU
Gas Piping
Sprinklers
_Shutters
(Affidavit required)
_Windows/Doors
Pond
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �i�k1-Lt�b Lh�"L�►
Name: c �U�i�PvU �2L(�-
Address: __$551 5w «% ��
Company: �{74(or> L21L'(�2.tG
City: M I �1 � State: �FL..
Zip Code: 3J 15� Fax:
Phone No. %$ 6 2',�Xo $Z�- ( 1 E-
Address: I OO/oj 5ta lg'S T�'Rlrt.
City: Wtl A� I State�C
Zip Code: 3 3 1 ?� Fax:
q-'llo�'
Phone Nor. -
Mail: CI.G�t)tU1�ZbKS � C6ritC�4S7�, )c.�21'
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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E-Mail SyIA�iO ¢�tC�✓IC I ►.>L @ �Dldat .Co'wf
State or County License �c 130051053
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY: _Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
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 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
with lender or ttorne before commencin work or recordin our Notice of Commencement.
Signa re ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 1�1//�M-i D/�1-i)�
Sworn to (or affirmed and subscribed before me of ✓Physical Presence or Online Notarization
this 12 day of C� t��' , 20� by
Name of person ma ing statement.
Personally Knowny OR Produced Identification
Type of Identification Produce
2�1. �ledhawd��
(Signa re of tart' Public- State of Florida)
Commission No. (sear ��Z�••¢�`f'�>�
COmm �GG952003
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
rcev 5/�u/11
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Ma.DEt #� !2 0 3� cc7 l o U
Ido �,titP �� N�r...ess
v uD�� ��ouN � MET�R�
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ST. LUCIE `���,..��LL�C=��N
Electrical Affidavit
Date I o (f 2 (21
Parcel ID # 25`32 ,SCjO..G�p24-Ooo � �I
Address 4045 W�7�-�d�6 W�
Permit # ��rosp ��x•d�� c�r�s'h����-�
I have requested to install an additional electric service/meter at the above named property. By
signing this affidavit, I fully agree that the additional electrical service/meter does not allow for
the following:
• Operation of a business venture or entity within the accessory structure
• Renting or leasing any portion of the accessory structure
• Converting accessory structure into additional occupied or living space
fully understand that if the conditions of this affidavit is found in violation, power may be shut
off to the building without notice.
�411-Lm S C-q-tS1,+�
Print Owner's Name Signature of Ow
STATE OF FLORIDA, COUNTY OF V�tI A-M l D�i�o�
SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME OF YSIC�AL_PlESENLE�R
ONLINE NOTORIZATION THIS DAY OF Zp ,
NAME OF PERSON MAKING STATEMENT Ca Q I03 C.a•� 2._y
PERSONALLY KNOWN � OR PRODUCED IDENTIFICATIO
TYPE OF IDENTIFICATION PRODUCED
Z v (� �C'iriR k�e'Z.
SIG URE O ARY P LIC TYPE OR PRINT NOTARY
C ISSION NUMBER p�� �^�Q
�•r.v EAL) �.6t� f1a111a1R�
'' ` Comm.�GG952003
�� '"= Expires: feb.16, 2024
PLANNING &DEVELOPMENT SERVICES � BUILDING DIVISION
1' 230U Virginia Avenue � Eorl Pierce, FL 3a9A2 � (77Z) -iG7 - l»3 _ (772) 462 - 1�28 �-� (772) 4(2 - 1.575 �e www.;tlucieco.gov