HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date'. February 7, 2017 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropboX, click arrow at the end of line
PROPOSED AAPROVEMENT LOCATION:
Address: 141 SE SERENATA COURT
Legal Description: RIVER PARK- UNIT 5 BLK 46 LOT 25 (MAP 341281 (OR 904-1781)
Property Tax ID #: 3419-MO0129-000-4 Lot No. 25
Site Plan Name: Block No. 46
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED' DESCRIPTION OF WOOF" TIM
REPLACE EXISTING EXTERNAL DISCONNECT.
CONSTRUCTION INFORMATION:
jditiona wor to e e orme under tis permit — c heck a appy :
1L (HVAC nGas Tank ❑Gas Piping Shutters
I❑Windows/Doors
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❑✓Electric El Plumbing []Sprinklers 1:1 Generator I,sl Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 699.00 Utilities: ❑Sewer ❑Septic Building Height:
OWNER/LESSEE:
Name GORDON W. & ELAINE F. KUCZYNSKI
Name: CHRISTOPHER W. RICHMOND
Address: 120 NE CAPRONA AVENUE
Company: RICHMOND ELECTRIC, INC
City: PORT ST. LUCIE State: FL
Address: 3086 ENTERPRISE ROAD
City: FORT PIERCE State: FL
Zip Code: 34983 Fax:
Phone No.
Zip Code: 34982 Fax: 772-461-1907
E -Mail:
Phone No. 772-461-1951
Fill in fee simple Title Holder on next page I if different
E -Mail: DEANAQRICHMONDELECTRICINC.COM
State or County License: EC0001963
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
COUNTY OF -LUCE
Address:
The forgoing instrument was acknowledged before me
FCEYK.4
City:
Zip: Phone:
State:_
City:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
(Signature of Notary Public -State ofy6rida)
Address:
Personally Known x OR Produced Identification
City:
Type of Identification Produced
City:
Commission No. FF909xx
Zip: Phone:
.0 Ndrry Pudic ataudfMallx
Zip: Phone:
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 Germit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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.
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_ Signature o Owner/ Lessee/Agent
Signature of o ractor/Ucense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF sL LDCIE
COUNTY OF -LUCE
The fo,,CC$$�ing instr ent was acknowledged� ,b,gfore me
The forgoing instrument was acknowledged before me
FCEYK.4
this )j_day of 20 [�by
thisg day of C11� .20 /26y
CHRISTOPHER W. RICHMOND
CHRISTOPHER W. RICHMOND
(Name of person acknowledging)
(Name of person acknowledging)
* i
I
(Signature of Notary Public -State of Flor'd )
(Signature of Notary Public -State ofy6rida)
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
_
Type of Identification Produced
Type of Identification Produced
Commission No. FF
Commission No. FF909xx
Moon MD eyed Fblki
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