HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 5-22-2019 Permit Number:) . No J
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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 x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 3100 ST. LUCIE BLVD
Legal Description: SAN LUCIE PLAZA S/D - UNIT ONE - BLK 62 LOTS 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17
18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 AND 36 (MAP 14/29S) (OR 297-1516)
Property Tax ID #: 1428-702-1420-000-9 Lot No. 1 - 36
Site Plan Name: NORTHSIDE WORSHIP CENTER, INC. Block No. 62
Project Name:
Setbacks Front Back: Right Side: Left Side:
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INSTALL ONE 50A, 120/240V BRANCH CIRCUIT TO ACCOMMODATE WP RV RECEPTACLE.
INSTALL ONE 30A, 120V BRANCH CIRCUIT TO ACCOMMODATE WP RV RECEPTACLE.
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itiona work to e e orme under this permit - check a apply:
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❑HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
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ZElectric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 1,396.00 Utilities:InSewer Septic Building Height:
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Name NORTHSIDE WORSHIP CENTER, INC.
Name: CHRISTOPHER W. RICHMOND
Company: RICHMOND ELECTRIC, INC
Address: 3100 ST. LUCIE BLVD
City: FORT PIERCE State: FL
Address: 3086 ENTERPRISE ROAD
City: FORT PIERCE State: FL
Zip Code: 34946 Fax:
Phone No.
Zip Code: 34982 Fax: 772-461-1907
E-Mail:
Phone No. 772-461-1951
E-Mail: DEANA@RICHMONDELECTRICINC.COM
Fill in fee simple Title Holder on next page ( if different
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.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 our Notice of Commencement.
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_ Signature of Owner/ Lessee/Agent
Signature of Contra for/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST.LUCIE
COUNTY OF ST.LUCIE
The forgoing instrument was acknowledged before me
this day of 20 by
The forgoing instrument was acknowledged before me
this � day of 20 �� by
CHRISTOPHER W. RICHMOND
CHRISTOPHER W. RICHMOND
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- S ate of Flo r )
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification Produced
Type of Identification Pro
Commission No. FF9090 0.rP Nota /�,� 1
ry r uo{ib State of Florida
Deana M Dailey
M Commission FF909099OOFrLo
+*Rr ��e Noubl' State of Florida
Commission No. FF909099 L.
Deal' NTi7Ailey
'� .- �,,� My Commission FF 909099
Expires 08/1212019
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Revised 07/15/2014
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