HomeMy WebLinkAboutpermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/1/2021 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropboX, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1200 PARKLAND BLVD
X
Legal Description: RIVERDALE YACHT CLUB ESTATES- UNIT 2 PLK 4 E 112 OF LOT 18 AND ALL LOTS 19 AND
20 (0.36 AC) (OR 301-1707; 3931-1271)
Property Tax I D #
Site Plan Name:
3409-703-0038-000-7
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No. 18, 19 8, 20
Block No. 4
INSTALL 20A/240V POWER FOR RESIDENTIAL LIFT STATION. LIFT STATION INSTALLED BY
OTHERS.
CONSTRUCTION INFORMATION:
Additiona I worK to a er orme 11 ei t E permit — c ec a app y:
❑HVAC Gas Tank Gas Piping _Shutters [E]Windows/Doors
❑✓ Electric El Plumbing oSprinkiers � Generator � Roof
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
500.00
SQ. Ft. of First Floor: n
Utilities: Sewer t �� Septic
Name LORI L BLAZER
Address: 1200 PARKLAND BLVD
City: FORT PIERCE State: FL
Zip Code: 34982 Fax:
Phnna Nn_
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: CHRISTOPHER W_ RICHMOND
Company: RICHMOND ELECTRIC, INC
Address: 3086 ENTERPRISE ROAD
City: FORT PIERCE State: FL
Zip Code: 34982 Fax: 772-461-1907
Phone No. 772-461-1951
E-Mail: DEANA@RICHMONDELECTRICINC.COM
State or County License: EC0001963
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
WARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE
JOB SITE BEFORE THE FIRST INSPECTION.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING
WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER'S ELECTRONIC SUBMISSION STATEMENT: Under penalty of perjury, I declare that all the information
contained in this building permit application is true and correct.
Must be sigi3ed byow er/agent an applicant:
(Signature of contractor)
State of Florida, County of St. Lucie
Affirmed to and subscribed before me this aVVb�r
1, , 20 21 , by Christopher W. Richmond
personally known tome or who has produced
as identification,
Notary
L,f L, M
(Signature of Owner or Agent (inclfiding contractor))
State of Florida, County of St. LUCie
Affirmed to and subscribed before me this
20 21 , by Christopher VV. Richmond
_onaerslly known to me or who has produced
as identification.
Notary
C.
Noiary�oblic Stale of Florida " Notary Public State of
Florida
Deana M Dailey Deana M Dailey
Notary (print name) Dean I My Commission 23 3Nb1ary ( int name) DeanaMy "t'T"Exp seeret$ion GG GG 3zests
an
Construction documents must accompany is a p i at o n r de submitted becomes an integral part of is plan an must
pass final inspection. "Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public record of this county, and there may be additional permits required from other governmental entities such as waste
management district, state agencies, or federal agencies. "SIGNATURE OF THE APPLICANT MUST BE NOTARIZED. If owner builder,
applicant must sign in person. BUILDING PERMIT includes: Building, Electrical, Plumbing, Mechanical, and Sewer only. All other trades
require separate applications_
Asbestos compliance: It is the owner's or operator's responsibility to comply with section 469.003, Florida Statutes, and to notify the
Department of Environmental Protection of his or her intentions to remove asbestos, when applicable, in accordance with state and federal law.
FEE SIMPLE TITLEHOLDER, BONDING COMPANY AND MORTGAGE LENDER INFORMATION IS REQUIRED WHEN
THE AGGREGATE VALUE (TOTAL COST OF ALL IMPROVEMENTS AND NOT JUST WORK AUTHORIZED BY THE
INDIVIDUAL PERMIT) IS $2500 OR MORE (EXCEPT HVAC REPAIR/REPLACEMENT-< $7500). PLEASE ADDRESS ALL
ITEMS.
Fee Simple Titleholder's
Name (if other than owner):
Address:
City:
Mortgage Lender's
Name:
Address:
City:
❑ Same as Owner
State: Zip:
❑ Not Applicable
State: Zip:
Bonding Company 0 Not Applicable
Name:
Address:
City: State: Zip:
OFFICE USE ONLY
Is the property located in a Special Flood Hazard Area (floodplain) per the current Flood Insurance Rate Map (FIRM}
❑ Yes ❑ No
Flood Zone: Reviewed by: Determination:
Permit Fee
State Surcharge $
Subcontractor $
Other
Other
Flood Review Fee
Total Amount Due at Issuance S
Remarks
Reviewed by Date Final Check
Plan Review Fee
Routing Fee $
Other $
Active Code Violation ❑ Yes ❑ No
Case #
Case Type
Date
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Septic
Tank