HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7/1/2019 Permit Number:
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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 Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 10619 PINENEEDLE DRIVE
Legal Description: PINE HOLLOW - UNIT TWO - LOT 22 (1.016 AC) (OR 1718-2408)
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALL 240V 60 AMP CIRCUIT FOR NEW POOL HEATER.
2321-802-0024-000-8
Lot No. 22
Block No. 2
Additional worK t0 be ertormeci under tnis permit — cneCK all n t apply:
�HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 200.00 Utilities:cn Sewer ESeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name SCOTT & STEPHANIE KIMMELMAN
Name: THOMAS E. RICHMOND
Address: 10619 PINENEEDLE DRIVE
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
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: _
Address:
City:
Zip:
Phone:
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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
commencine work or recordinia vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF ST IUCIE
STATE OF FLORIDA
COUNTY OF ST LUCIE
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this � day of� 20 L'�_by this day o 1 �V 20 by
THOMAS E. RICHMOND THOMAS E. RICHMOND
(Name of person acknowledging) (Name of person acknowledging )
at-o'Aa �-k. �A )0_t b-,
(Signature of Notary Public- State of Flori
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
(Signature of Notary Public- State of Flori
Personally Known x OR Produced Identification
Type of Identification Produced
NoOf OlkIic State of Florida Commission No.
Deana M Dailey
or F��' txpires 08/12/2019
-W" "oo,^ NoWf public State of Florida
Deana M Dailey
• :, a My Commission FF 909099
o�n Expires 08/12/2019
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