HomeMy WebLinkAboutEC Permit App for 100 N Brocksmith- Cody HarrisAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3I 6I 7--2- Permit Number:
�`1-uL�1i�CLL ..
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 CBDG Funding
PERMIT APPLICATION FOR: Electrical
PROPOSED IMPROVEMENT LOCATION:
Address: 100 N Brocksmith RD Fort Pierce FL 34945
Property Tax ID it: 2308-133-0007-000-9 Lot No.
Site Plan Name:
Project Name: _ Harris Residence
DETAILED DESCRIPTION OF WORK:
Install 6/2 romex from panel to AHU
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical
X_ Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ $650
_ Gas Piping
_ Sprinklers
_ Shutters _
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Block No.
Utilities: _Sewer _Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Cody Harris
Name: Michael Prici.
Address: 100 N Brocksmith Road
Company: Pride Electrical Services of Florida
City: Fort Pierce State:
Zip Code: 34945 Fax:
Phone No. E-
Address: 843 S Kings Hwy, 102-B
City: Fort Pierce State: FL
Zip Code: 34945 Fax: 772-461-2778
Phone No 770-170-6894
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail mike@pride-electrical.com
State or County License FC:1400585q / 29,97S
..�.-�„ „ ��,,,, ur more, a nca.unucu nonce or commencement is required. II
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:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 y. A Notice of Commencement must be recorded in the public records of St.
Lucie County and p ed on th jobsite before the first inspection. If you intend to obtain financing, consult
with I r an me bef re commencing work or recordin our Notice of Commencement.
SAL
Sithatufe of Contractor or wner Builder as applicable
STATE OF FLORIN
COUNTY OF
Swo(or affirmed) and subscribed befQQ me of �hysical Presence or _ Online Notarization
thisr o day of 20AW by
Name of person making st tement.
Personally Known OR Produced Identification
Tyentificatign Produced
ll ���� ttQQ�/(CIS �ll /—
(Signature of Notary Public- State of Florida)
Commission No. t�! a �-7 (Sea[) David Raymond Prue
NOTARY PUBLIC
STATE OF FLORIDA
Comma GG287052
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