HomeMy WebLinkAboutPermit application.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 02/28/2022 Permit Number.-
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' 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: Electrical service change
PROPOSED IMPROVEMENT LOCATION:
Address: 196 Northeast Caprona Avenue, Port St. Lucie, FL 34983
Property Tax ID #: 3419-530-0282-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: I
Electrical service change
New Electrical Meter Second Electrical Meter
(Affidavit required)
I CONSTRUCTION INFORMATION: i
Additional work to be performed under this permit —check all that apply:
Mechanical — Gas Tank Gas Piping _ Shutters _
Vctric _ Plumbing _Sprinklers Generator
Total So. Ft of Construction: Sq. Ft. of First Floor:
Windows/Doors Pond
_ Roof Pitch
Cost of Construction: $ 4,476.54 Utilities: Sewer _Septic Building Height:
OWNERAESSEE: - CONTRACTOR. -
Name Rodriguez, Tomas Name: Lazaro Y. Le orburo
Address: 196 Northeast Caprona Avenue Company: America Statewide Electrical Contractor Inc
City: Port St. Lucie State: R Address: 9571 NW 24th St
zip Code: 34983 Fax: City: Sunrise State: FL
Phone No. E- Zip Code: 33322 Fax:
Mail: Phone No 786 718-9398
Fill in fee simple Title Holder on next page (if different E-Mail Lazaro@americastatewide.com
I from the Owner listed above) State or County License EC13009593
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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
State:
Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: ^Not Applicable
Name: _
Address:
City:
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 an attorney before commencing work or recording your Notice of Commencement.
iSignature of Contractor - or - OuMer Builder as applicable
STATE OF FLORIDA — -
f COUNTY Of `i
Swor to (or affirm d) an Subscribed before me of Physical Presence or Online Notarization
this day of ti. 20a-_,�by
Name of person making statement.
Personally Known OR P uce enti l tion V
Type of Icjentification Produced �� I
(Signature oLNota�y Public- State of Florida)
Commission No. `�Seao
No" PuMc $1L1sof Flarids
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REVIEWS FRONT ZONING
SUPERVISOR
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COUNTER REVIEW
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