HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/9/2020 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: 5904 BALSAM DRIVE
Legal Description: INDIAN RIVER ESTATES- UNIT 09- BLK 88 LOT 1 (MAP 34/12S) (OR 774-1111)
Property Tax ID#: 3402-610-0533-000-1 Lot No. 1
Site Plan Name: Block No. 88
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
REPLACE EXISTING SINGLE PHASE 200A MAIN BREAKER, METER MAIN COMBO. INSTALL
2nd GROUND ROD AND TIE TO EXISTING GROUNDING ELECTRODE SYSTEM,
INSTALL 2 POLE 30A BREAKER, INTERLOCK CLIP, CABLING AND POWER INLET IN GARAGE.
CONSTRUCTION INFORMATION:
Additional to eta under this permit—check all h apply:
❑HVAC Gas Tank ❑Gas Piping L—I Shutters Q Windows/Doors
PIElectric ❑ Plumbing Sprinklers Generator El Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 2,117.00 Utilities:CnSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name MICHAEL J REVELS Name: CHRISTOPHER w. RICHMOND
Address: 5904 BALSAM DRIVE Company: RICHMOND ELECTRIC, INC
City: FORT PIERCE State: FL Address: 3086 ENTERPRISE ROAD
Zip Code: 34982 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: DFANA@RICHMONDELECTRICINC.COM
from the Owner listed above) State or County License: ECO001963
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.
_Signature of Ow er/Lessee/Agent Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST.LUCIE COUNTY OF STAUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this C(—day of W0UV_rV%4aItAL,. , 20Z�D by this— day of Kjc;PC lk Z , 207 i�by
CHRISTOPHER w,RICHMOND CHRISTOPHER w RICHMOND
(Name of person acknowledging) {Name of person acknowledging}
lg�2L�
{Signature of Notary Public-State of Flo ) (Signature of Notary Public-State of Florida }
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced }
GG 326�T ommission No. GG 32651 r� No D.Skate of Florcda
Commission No. No ery Public Skate of Florkda tf
Deana M Dailey r Deana M Dailey
My Commission GG 326516
o•,� ExpHes OW12/2023 °f�`
Revised 07/15/2014 „
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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