HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11-2-2018 Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
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
ROVEMENTLOCAT- .: m.
Address: 10646 PINE NEEDLE DRIVE
Legal Description: PINE HOLLOW - UNIT TWO - LOT 12 (1,018 AC) (OR 1718-2413)
Property Tax ID #: 2321-802-0014-000-5 Lot No. 12
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALL 20A 120 VOLT WEATHERPROOF RECEPTACLE AND WARNING LIGHT FOR SEPTIC
TANK PUMP.
CONSTRUCTION INFORMATION:
IId�itlIiona workto a erorme un ert ispermit-c hecka appy:
0 Gas Tank Das Piping _Shutters ❑Windows/Doors
FHVAC
L� (Electric OPlumbing Sprinklers 1:1Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 600.00 Utilities: �nl Sewer OSeptic Building Height:
Name JEREMY C. MCWHORTER
Name: THOMAS E. RICHMOND
Address: 10646 PINE NEEDLE DRIVE
Company: RICHMOND ELECTRIC, INC
City: FORT PIERCE State: FL
Address: 3086 ENTERPRISE ROAD
City: FORT PIERCE State: FL
Zip Code: 34945 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( if different
E -Mail: DEANA@RICHMONDELECTRICINC.COM
State or County License: EC0001963
from the Owner listed above)
N value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
LIEN
DESIGNER/ENGINEER:
Name:
FRONT
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
SEA TURTLE
MANGROVE
Address:
COUNTER
City:
Zip:
Phone:
State:_
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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
_ Signature of Owner/ Les ee/Agent Signature of Contractor/Lice hse Hol er
STATE OF FLORIDA
COUNTY OF sr.—,c
The forgoing instrument was acknowledged before me
this dayof NW,1LW .IciQxi . 20 f& by
STATE OF FLORIDA
COUNTY OF ar ---
The forgoing instrument was acknowledged before me
this 2 day ofNJOVA^ L, n. . 20 LV_ by
THO WkS E. RICHMOND 1HOMNa E. RICHMOND
(Name of person acknowledging) (Name of person acknowledging)
M_
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Pro rt� t ue Type of Identification Produced
Commission No. RRwww ��F S�MFlan� Commission No. HE www _",iµ, Notfi§(Palc Sura of FkMN
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS