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Home My WebLink AboutBUILDING PERMIT APPLICATION - ELECTRICIAL PERMIT1•ti DATE FILED: BP PLAN REVIEW FEE: ' CT7 RECEIPT NO.: y7��P• PERMIT NUMBER: ti�vr� CONCURRENCY FEE: c; f M 'RECEIPT NO.: CERT. CAP. NO • _ `{ ��..•k �•F s ALL INFO MAST BE COMPLETE FILLED IN TO BE AClitEpTED A ��e coo 7SECCTIONT:,R M TOWNSHIP: 2 /_ RANGE: MAP NO.: /a� C ,� ® y ST. LUCIE COUNTY PUBLIC WORKS I �J BUILDING R ZONING DEPARTMENT 2300 VIRGINIA AVENUE _ _ - OR10P FORT PIERCE, FL 34982-5652 ZONING: _ /� t% I LAND USE: I ' LOT CVGa� _ ` TAZ NO.: 772-462-1553 I . FLOOD ZONE: n FIRM MAP #: g� 1ST FLR ELV: / MAX HGT: APPLICATION for BUILDING PERMIT CERTIFICATE of CAPACITY/ZONING COMPLIANCE CST TYPE: P" OCCP TYPE: /( MAX. OCCP: - # OF FLRS: f ` PROJECT INFORMATION t WATER: SEWER: SPRINKLERS STORMWATE 1. LOCATION/SITE ADDRESS: .S 5'y 1 j � dd r,,, R i one l, b r Y /� U L 3 i( 9 3 R 2. S/D NAME: SITE PLAN NAME: LOT OF REC (beff 1190) LOT OF REC (aft r 1/90) LOT SPLIT LOT SPLIT r REa'D APPRV'D 3. PROPERTY TAX ID&10OO Oc;L - DO 0—Q— ECA ` 072 4. LEGAL DESCRIPTION (attach extra sheets if necessary� ): i Ztka n �^ `� "DECAL LIBRARY 9 PARKS PERMIT NUMBER _ IMPACT FEE �11 j. LL IMPACT FEE L4 8 y, FEE j REPORT PUBLIC BLDG 4 Sri 7 HABITABALE RADON FEE CODE IMPACTFEE AREA 5. PLAT. �i 6.. -PAGE L f�n �I�.f27. BLOCK /1 "8. LOT 0 I F3 a- (a% (RADON) BOOK is NO. I4 I I�fAt (q NO. pL NO. / S i Q, I' Y) Y N >' a X ' ROAD GROSS ROAD CREDIT TOTAL ROAD t': S IMPACT ZONE IMPACT FEE IMPACT FEE 9. PARCEL SIZE: ACRES/SO FT. ' LOT DIMENSIONS _ 4 DUE 10. DESCRIPTION OF, CONSTRUCTION PROJECT ORWORK ACTIVITY: 3I3//ate SCHOOL- CREDIT =G �. -_. '" TOTAL IMPACT FEE >:ws_�:::_<s:`<a'><:> xr:#x>:>::'>5:: SCHOOL qG (p �° iMPACT FEE 11. SETBACKS (ACTUAL) FRONT: ,-" BACK' RIGHT LEFT CS) _ SIDE SIDE: 20O f POLICE FEE FIRE FEE ,MISC FEES: TOTAL —7 U cy 1, A Lt' g 3 YYl S q iS�f= 4 p� PMo �c�EsEf 1 12. TYPE OF CONSTRUCTION (Check all appropriate boxes) 31 5 / O Y N � t •v� b II 4' I l EXPANSIOWADDITION � NEW CONSTRUCTION [ ] INTERIOR RENOVATION ADDITIONAL SPECIFY: d1/1 _p Q^�}L TOTAL ALL l j/'RESIDENTIAL PERMITS Y � �Ci'l. �S-KJ' FEES [) COMMERCIAL [ ] INDUSTRIAL REa'D [ ] 'OTHER (SPECIFY) �RiUZ;1,liQ �Q.Rfrlt� (� S 13. DESCRIPTION OF PROPOSED USE: IilA Plel/ Vu i � � �(�� nl f �� ✓es( co — REVIEWS ZONING ZONING PLANS I'VEGETATION SF1t , MANGROVE J 14. Sq. FUCONSTRUCTION: `"1'C�`L l 15.. Sq. Ft. 1 st Floor .REVIEWEDBY EXAMINING TURTLE DATE 111 (d j r I I D� 1 1 � / .a0b 8�i 16. VALUE OF CONSTRUCTION: $ COMPLETE I Vlj [�U The value of construction is used to determine the amount of permit fees to be assessed. St Lucte County reserves the right to question and/or modify We INITIALS Indicated value of construction if it Is demonstrated that the submitted figures are not consistent with simBar types of construction activities. If the value is $25W v c�}/ or more, a RECORDED Notice of Commencement most be submitted with this application. i G ;LCCDV Form No.: 00"2 CERTIFICATION: JWNER INFORMATION, �( C11 a4 11� + V 5 This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of �i t capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to he issuance of a permit JI 5 S� Syl�l ho — and that -all -work -will -be -performed -to meet-the-standards-ofalLlaws_regulating construction in this jurisdiction. I understand that ADDRESS: J `� TANKS, AND AIR ONDITIONERSrate permits may be required I, ETC., otherwise included SIGNS, his building permit applELLS, POOLS, ication. BOILERS, HEATERS, /+ STATE: ZIP- . PHONE (DAYTIME): 1l 1 �1� � I J � I �yy Ce,(' IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS BELOW. FEE SIMPLE TITLEHOLDER: - ADDRESS: CITY: STATE: ZIP PHONE (DAYTIME): CONTRACTOR INFORMATION ST. of FL REGJCERT #: Q �,ti11GE !C BUSINESS NAME- QUALIFIERS NAME: ADDRESS: CITY: PHONE (DAYTIME): r 1 ARCHIT/ENGINEER: ADDRESS: CITY: PHONE (DAYTIME): BONDING COMPANY:' ADDRESS:: CITY: MORTGAGE LENDER: ADDRESS: CITY: ST. LUCIE COUNTY CERT #: � (c�1 zc,( C r A-4 �SIM O,qpiti PY-O Vl n 6b 'vv✓h r-r D�S; STATE: ZIP FAX NO. STATE: ZIP ` S STATE: ZIP STATE: ZIP IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 dmfs after notification it will be voided and returned to you by mail. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures (all types), swimming pools, fendes, walls, signs, screen rooms, utility substations & accessory uses to another non- residential use. NOTICE TO OWNER: 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. NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT. TITLE, AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. OWNER/CONTRACTOR SIGNATURE CONTRACTOR SIGNATURE r STATE OF FLORIDA STATE OF FLORIDA COUNTY OF �{ L LLd ¢ COUNTY OF The foregoing ment was acknowledged The foregoing instrum was acknowledged before me this "'day of Qt6 2tf?�by LOW-M yl< before me this _ d of 20_, by who is personally knot 9�e or who o is personally known to has produced �US�'f s- iif�fi}ication. or who has pro ced as identification. 1. S nature of tary Signat of Notary a wZGncoc env Type or Print Name of Notary Ape of Print Name of Notary Notary Public Title / Notary Public Title NOT!>2tY PUB OF FLORIDA /// COEaamis§IW6M oycochea Commission Number (seal) ,)Commission#DDS89694 (seal) BONDED 'THRuAn NnC 07 BONDING CO OINC NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNE"UILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION. MASTERPERMIT: • - .I PERMIT Pi OSMER: ST. LUCIE COUNTY PUBLIC WORKS BUILDING & ZONING DEPARTMENT 2300 VIRGINIA AVENUE FORT PIERCE, FL 349825652 561-462-1553 APPLICATION FOR ELECTRICAL PERMIT SEE REVERSE SIDE FOR INSTRUCTIONS DATE: (o 1. LOCATIONISITE ADDRESS: 2. PARCEL ID NUMBER: / Or'sT u ci fL c3 141983 SECT TWP RNG MAP I ZNG LU I/NIT 3. DESCRIPTION OF PROJECT OR WORK ACTIVITY: 4. OWNERS INFORMATION. 5. CONTRACTORS INFORMATION Name: FL REG/CERT#: Address: COUNTY CERT #: City: State: Business Name: Phone: Zip: 6. VALUE OF CONSTRUCTION: $ so O ' FEES DUE: RECEIPT: 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 allapplicablelaws regulatingggCConsWdion and zoning. �C3iR7 PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER- --STATE OF FLORIDA, COUNTY OF. SWORN TO AND SUBSCRIBED BEFORE ME THIS �AY OF 207_,BY �T • �t WHO IS PERSONALLY KNOWN TOME OR WHO HAS PRODUCE I�j�.ID _AS IDENTIFICATION. ``��pNUF�IL Lauri L 4 GNAT R OF NOTAR TYPE OR P INT NAME OF NO RY NOTARY PUBLIC ITLE DD/e1316 COMMISSION NUMBER $ o ; 'PDD 3 NOTICE TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOV P ING ,1 ( IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT Wrft6{�Ii1�N ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. z/C o .. H; . �� ST. LUCIE COUNTY • — ELECTRJCAL PERMIT INSTRUCTIONS Please complete alHnformation-in-the-space-provided.. All-information-must-be-P-rinted-(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: ............. 2. PARCEL ID NUMBER: ...................................... ................. 3. DESCRIPTION OF PROJECT OR WORK ACTIVITY........ 4. OWNERS INFORMATION:.......... 5. CONTRACTORS INFORMATION:....... 6. VALUE OF CONSTRUCTION:....... Indicate the street address, or general location, of the property on which the building activity is taking place. Indicate the Property Tax Identification Number for the property on which the building activity is taking place. Briefly describe the building activity under permit application. Indicate the name and address of the owner of the property on which the electrical repair or replacement is taking place. ..... Indicate the State of Florida (if applicable) and St. Lucie County contractors registratidn numbers, and the name of the business doing the electrical work. ...... 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 Permit's 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 will be accepted for processing after 4:30 P.M. For assistance in completing,,this,application, please contact the St. Lucie County Building and Zoning Department, at (561) 462=1553, .during:,�egular office hours (8:00 AM - 5:00 PM), Monday through Friday. calling (561) 462.-1261.