HomeMy WebLinkAboutCCE11152017ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/15/2017 Permit Number:
CC)UNTY
L o R 1 v A
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: 11635 WILLIS ROAD
Legal Description: 9 35 39 E 165 FT OF N 294 FT OF W 1/2 OF NW 1/4 OF SE 1/4 OF SW 1/4 -LESS N 30FT FOR RD
R/W - (1.00 AC) (OR 3780-2021)
Property Tax ID #: 2309-342-0003-000-6
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
REPLACE EXISTING 200A MAIN BREAKER
Lot No._
Block No.
Jditional work to be pertormed under this permit — check all that apply:
11 HVAC IJ Gas Tank ❑Gas Piping F] Shutters 0 Windows/Doors
Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: _
Cost of Construction: $ 300.00
SFt. of First Floor: _
Utilities:cnSewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name JOHN J BRADY JR
Name: CHRISTOPHER W. RICHMOND
Address: 11635 WILLIS ROAD
Company: RICHMOND ELECTRIC, INC
City: FORT PIERCE State: FL
Zip Code: _34945 Fax:
Phone No.
Address: 3086 ENTERPRISE ROAD
City: FORT PIERCE State: FL
Zip Code: 34982 Fax: 772-461-1907
Phone No. 772-461-1951
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: DEANA@RICHMONDELECTRICINC.COM
State or County License: EC0001963
IT value OT construction is >)LWU or more, a KECUKDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
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
commencini=_ work or recording vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent Signature of Con ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sr LuaE COUNTY OF ST LUCRE
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Noll Yl9t, 20 "by this J�day ofNOVeZ-;ij6ei�[ , 20,7 by
CHRISTOPHER W. RICHMOND CHRISTOPHER W RICHMOND
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Public- State of Flo ri (Signature of Notary Public- State of Flori
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. FF 90 Commission No. FF 90909
,)A' f,,i Notary Public SUte Of Florida o��r °6eL Notary Public State of Florida
ro �^ Deans M Dailey = Deana M Dailey
1 c y mmissWnOF govow Mal
Revised 07/15/20 +1oF �oF Expires 0611272019 9'For ft° Explrs6 08/12/2019
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