HomeMy WebLinkAbout23030401 APPLICATION FOR ELECTRICAL PERMITMASTER PERMIT: J - -T.ERMIT NUIV
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2.
ST. LUCIE COUNTY PUBLIC WORKS
BUILDING & ZONING DEPARTMENT
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
561-462-1563
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' APPLICATION FOR
ELECTRICAL PERMIT
SEE REVERSE SIDE FOR INSTRUCTIONS
LOCATION/SITE ADDRESS:
PARCEL ID NUMBER: l �'
SECT 1 1 1 TWP Q J 1 RNG
MAP
3. DESCRIPTION OF PROJECT OR WORK ACTIVITY:
Name:
Address
City:
Phone:
Sjr - 0
BY
St LU60 CoUnty
DATE-3
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OWNERS INFORMATION / �G 5. CONTRACTU11b IIN�JrvRMATION
U �!�� it moo" FL REGICERT #: L—U�/ D L� C� Z Z
COUNTY CERT#:
State: �� Business Name:
Zip:
VALUE OF CONSTRUCTION: $ 091
FEES DUE:
-� -7, O'D
RECEIPT:QI `3i
NOTE: A SEPARATE PERMIT IS REQUIRED FOR A TEMPORARY POLE.
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be done in compliance with
all applicable laws regulating construction and zoning.
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PRINT QUALIFIERS/OWNERS NAME
STATE OF FLORIDA, COUNTY OF
SWORN TO AND SUBSCRIBED BEFORE ME THIS _
WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
X\W
RIM
QUALIFIER/OWNER
OF , 20_, BY
QED AS IDENTIFICATION.
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY (seal)
NOTARY PUBLIC TITLE COMMISSION NUMBER
NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
ST. LUCIE COUNTY ' / ELECTRICAL PERMIT
INSTRUCTIONS
Please complete all information lin the space provided. All information must be Printed (use, black or blue ink
only) or Typed.
This application for Electrical Permit to be used for only those activities that are not otherwise included under
a primary building permit. This application for Electrical Permit may not be used for any activity that includes
any type or kind of structural alteration. Building activities involving structural alteration, in addition to the
electrical work, must be permitted through the regular building permit review process. The information to be
provided with this application includes:
1. LOCATION/SITE ADDRESS:......................................:6....:.. Indicate the streetaddress, or general location, of the
property on which the building activity is taking place.
2. PARCEL ID NUMBER: ............ ........................................... Indicate the Property Tax Identification Number for the
property on which the building activity is taking place.
3. DESCRIPTION OF PROJECT OR WORK ACTIVITY........ Briefly describe the building activity under permit
application-,
4. OWNERS INFORMATION:..... I ........................................... Indicate the name and address of the owner of the
property on which the electrical repair or replacement is
taking place.
5.. CONTRACTORS INFORMATION: .................................... Indicate the State of Florida (if applicable) and St. Lucie
County contractors registration numbers; and the name
of, the.business doing the electrical work.
6. VALUE OF CONSTRUCTION: . .......................................... Indicate the total value of the electrical work to take
place. Total cost of construction includes all material
and labor costs associated with the
building/construction activity. The value of construction
is used to determine the amount of permitting fees to be
assessed. St. Lucie County reserves the right to
question and/or modify the indicated value of
construction if it is demonstrated that the submitted
figures are not consistent with similar types of
construction.
All applications for Electrical Permits are to be submitted to the St. Lucie County Building and Zoning
Department, St. Lucie County Administration Building, 2300 Virginia Avenue, Fort Pierce, FL 34982. All
applications for Electrical Permits must be complete and filed with the Department no later 4:30 P.M. each
business day. No applications lwillll be accepted for processing after 4:30 P.M. For assistance in
corbpleting this application, please contact the St. Lucie County Building and Zoning Department, at (561)
462-1553, during regular office hours (8:00 AM - 5:00 PM), Monday through Friday.
calling (561) 462-1261.