HomeMy WebLinkAboutBuilding Permit Application • C ,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: 5110116 Permit Number:
` MAit 20 6
Buil Per
mit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34992
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To $elect from dropbox, click arrow at the end of linek.-I
Address: 10630 PINE NEI=DLE DRIVE
Legal Description: PINE HOLLOW-UNIT TWO-LOT 8(1.003 AC)(OR 2563-2397)
Property Tax ID#: 2321-802-0010-000 7 Lot No. 8
.Site Plan Name: Block No.
Project Name: RICHMOND
Setbacks Front Back: Right Side: Left Side:
TEMPORARY POLE
1111!Add�ititio3rhial�workto�be-ei3e�rlNui cler tnis permit—cec all app y:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers [Generator F1 Roof
Total Sq.Ft of Construction: ScFt Ft.of First Floor:
Cost of Construction:$ 500.00 Utilities:Ln Sewer Septic Building Height:
Name THOMAS E.&JACKIE RICHMOND Name: CHRISTOPHER W.RICHMOND
Address: 2717 S.19TH STREET Company: RICHMOND ELECTRIC,INC.
City: FORT PIERCE State: FL Address: 3086 ENTERPRISE ROAD
Zip Code: 34982 Fax:772461-1907 City: FORT PIERCE State:FL
Phone No.772-461-1951 Zip Code: 34982 Fax: 7/2461-1907
E-Mail: Phone No. 772-461-1951
Fill In fee simple Title Holder on next page(if different E-Mail: DEANA@RICHMONDELECTRICINC.COM
from the Owner listed above) State or County License: EC 0001963
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
...........
Name: ER/ENGINEER: Not Applicable Name:MORTGAGE COMPANY: _Not Applicable
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 apermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Associatlon 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.
/I/17f— s
Signature ofOwner/Le55ee/Agent Signature of Co tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF sr.woe COUNTY OF, sr.wale
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 Ll by this day of Q L ,20 by
GHRISTOPHER W.RICHMOND CHRISTOPHER W.RICHMOND
(Name of person acknowledging) (Name of person acknowledging)
' I I Vl J L11
(Signature of Notary Public-State of FIo da) (Signature of Notary Public- tate of Floriffl
Personally Known I{�Prret�etceddelegrl> 5as) Personally Known Xff
Type of Identiflcatlon meld Nate PubHe state of Flodda Type of Identification PrNotary Pudlic slate or Fbrida
Deana M Dalley eana alleyCommission NoFFa MY a�9908099 Commission No. Ff 9090My FF 969089
EScpeea�019
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Revised 07/15/20-14
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