HomeMy WebLinkAboutPermit application.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential V
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: 6506 Pensacola Rd, Fort Pierce, FL 34951
Property Tax I D #: 1301-612-0037-000-4 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Electrical service change
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _
�lectric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Cost of Construction: $ Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Henao, Francisco
Name: Lazaro Y. Legorburo
Address: 6506 Pensacola Rd
Company: America Statewide Electrical Contractor Inc
City: Fort Pierce State: FL
Address: 9571 NW 24th St
Zip Code: 34951 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 Lazarogamericastatewide.com
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
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 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 attornev before commencine work or recordine vour Notice of Commencement.
Signature of Contractor - or - Own Builder as applicable
STATE OF FLORIDA
COUNTY OF !�J_ . Utt s&T
Sworn to (or affirmed and su scribed before me of IV/Physical Presence or Online Notarization
day 2�py
this _ of
Name of person making statement.
Personally Known OR Produced Identification -
Type ofJoentificittion Produced$&L* 1000. c
(Sign%QgWof Notary Public- State of Florida)
Commission No. 40,610 S' g (Seal) .�' p"%, ASLAM M. HUSSAIN
MY COMMISSION # GG961059
�a�d' EXPIRES: April 09, 2024
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DATE
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DATE
COMPLETED
Kev lu/12/21