HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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) 462-1S78 Commercial Residential x
PERMIT APPLICATION FOR: Boat lift
PROPOSED IMPROVEMENT LOCATION:
Address: 269 MARINA DR
Legal Description: CORAL COVE BEACH -SECTION ONE- BLK 5 LOT 19 (OR 3634-2574)
Property Tax ID #:
Site Plan Name:
Project Name: KERN LIFT
Setbacks Front
Back: Right Side: Left Side:
Lot No.
Block No. 5
DETAILED DESCRIPTION OF WORK: I
INSTALL A BOAT LIFT AT AN EXISTING RESIDENTIAL DOCK
CONSTRUCTION INFORMATION:
Additional work to bfIrtormed under this permit — check a apply:
11HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
R1Electric ❑ Plumbing Sprinklers 11 Generator F]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities: Sewer O Septic
Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name FRED KERN
Name:
Address: 269 MARINA DR
Company: SAMSON MARINE CONSTRUCTION, LLC
City: FORT PIERCE State: FL
Zip Code: 34949 Fax:
Phone No. 781-718-7216
Address: L60a-- t ctClicr r
City: �tS-?n—G tx t State:
Zip Code: c '�`� 0 Fax:
Phone No. 772-713-7803
E-Mail: kern50440-@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: SAM.DURHAM85@YAHOO.COM
State or County License: (� 6,L 01
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: SEE BOAT LIFT SPECS
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:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
bylaws that may restrict or such
which is in conflict with any applicable Home Owners Association rules, or and covenants prohibit
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 Owner e/C ntractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA _111)
COUNTY OF A -el,
COUNTY OF
The fQr�oing ' r ment was acknowledged before me
The forgoing instrument was acknowledged before me
this day e ' 20:j�2> by
this Zy day of 20; by
Name of person making statement
.' _.l�lame_Rf person making statement
Personally Known OR Produced Identification
ersonall Knowp� i.— OR Produced Identification
Type of Id tific ion
Produceak ��- � � ����J j�2 ,y-��
Type of Identification
Produced
7 �
r ,
11
A 24
(Sig attire of :" ic- Sta��
®1f11�LIC
(Signature of No:41S'L7Expires
WCOWA ISM8 913717
�''�
Commission �. .-0*tWy
TATE OFIFCLQO'�IDA
Commission No. omm# Gc3�T2569
lcUnd ere
1/4/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17