HomeMy WebLinkAboutCCE07312017_0002ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7/31/17 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 IMPROVEMENT LOCATION:
Address: 5953 Spanish River Road
Legal Description: Portofino Shores - Phase Two - (PB 43-33) LOT 319 (or 3987-1668)
Property Tax ID #: 1312-502-0143-000-6 Lot No. 319
Site Plan Name: Shuttlesworth Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install three receptacles in garage, recess lighting in kitchen with dimmer switch.
CONSTRUCTION INFORMATION:
Additional work to be erformed under t ispermit — check atl that appll
HVAC Gas Tank 0Gas Piping _ Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S.Ft.j of First Floor:
Cost of Construction: $ 1,443.00 Utilities: I* Sewer E]Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Gerald & Pamela Shuttlesworth
Name: Christopher W. Richmond
Address: 5953 Spanish River Road
Company: Richmond Electric, Inc.
City: Fort Pierce State: FL
Address: 3086 Enterprise Road
Zip Code: 34951-2800 Fax:
City: Fort Pierce State: FL
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 ( if different
E-Mail: DEANA@RICHMONDELECTRICINC.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:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 permit 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 ofOwner/ Lessee/Agent
Signature of Co tractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST. LUCIE
COUNTY OF ST, LUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _day of 20 _by
this day of 20 by
CHRISTOPHER W. RICHMOND
CHRISTOPHER W RICHMOND
(Name of person acknowledging)
(Name of person acknowledging )
DATE
(Signature of Notary Public- State of Florida
(Signature of Notary Public- State of Florida
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification Pr
Type of Identification Pro
�,*I o"• nhtary n,,.,.,. --!e of Flo"la
pc,, Notary�Pubhc state of Florida
fl�art •�"v
Commission No. FF909 9% 4Seaip
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Commission No. FF90909 Dean��iley
909099
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My Coiss onFF
Expires 06112!2019
rfF'"" Expire112/2019
Revised 07/15/2014
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