HomeMy WebLinkAboutelectric permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
1� LLLCLL"-
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: Electrical Service Change
PROPOSED IMPROVEMENT LOCATION:
Address: 9224 Potomac Dr. Fort Pierce, FL 34945
Property Tax ID #: 2327-502-0111-000-2 Lot No.103
Site Plan Name: Block No. 4
Project Name:
DETAILED DESCRIPTION OF WORK:
Replace 150amD meter main.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical
Y Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping _ Shutters _ Windows/Doors _ Pond
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name D. R. Horton Inc.
Name: John Cavnar
Address: 1450 Culver Dr. NE
Company: Goldstar Electric. Inc.
City: Palm Bay State: FL
Zip Code:39g07 Fax:
Phone No. E-
Address: 213 NE Sagamore Terrace
City: Port Saint I urie State: FL
Zip Code: 34983 Fax:
Phone No 772-380-5913
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailiohncCcQgoldstar-electric.com
State or County License 23575
it vaiue at construction is Z500 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:
Address:
BONDING COMPANY: _Not Applicable
Name:
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 ari 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 an attorney before commencing work or recording your Notice of Commencement.
46��
ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORI A
COUNTY OF _ . L►UC_J
Swotn to (or affirmed) and subscribed before me of V Physical Presence or _ Online Notarization
this f: day of QC;;tMbr. ✓ 202A by
rYc;hn Cmnoir
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
Commission No. Q03 tog g�3 (Seal) yarxy Notary Public slate of Flonda
f `F Paa1a Bautista Garcia
a.w�My Comnxa MN 063663
Expires 11115f2024
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