HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE CO7MII
Date: a r� 14- a DID
FOR APPLICATION TO BE ACCEPTED
Permit Number: �, �Q�7� 5oi `
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
PERMIT APPLICATION FOR: Dockf6eswa E?0Ci { LWt
PROPOSED IMPROVEMENT LOCATION`
Address: 10701 S OCEAN DR LOT 887
4 A
c14 -S .
2�coo
A
Residential X
Legal Description: VENTURE OUT AT INDIAN RIVER INC LOT 887 ( OR 4249 -1149
Property Tax ID #: 4511-510-0088-000-7
Site Plan Name: GRUMSTRUP-ACKERMAN
Project Name: GRUMSTRUP-ACKERMAN
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: III
1. INSTALL A 196 SQ FT DOCK
2. INSTALL A BOAT LIFT
CONSTRUCTION INFORMATION:
itiona wor to e ertormecl under
❑HVAC
tispermit—check
❑Gas
all apply:
In
❑Windows/Doors
Gas Tank
Piping
_Shutters
❑Electric Plumbing
[]Sprinklers
❑Generator
❑Roof ❑ Roof pitch
Total Sq. Ft of Construction:
43,710.00
Sq. Ft• of First Floor:
IL��Sewer ❑Septic
Cost of construction: $
Utilities:
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name GRUMSTRUP, SUZANNE
Name: ROBERT WILLIAMS
Address:10701 S OCEAN DR. LOT 887
Company: WILCO CONSTRUCTION INC
City: JENSEN BEACH State: FL
Zip Code: 34957 Fax: NIA
Phone No. 507-649-9163
Address: 10751 ORANGEAVE
City: FORT PIERCE State: FL
Zip Code: 34945 Fax: 772460-6929
Phone No. 772-460-6928
E-Mail: NIA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: WILCOINC@BELLSOUTH.NET
State or County License: SCC131151026 29115
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: DANIEL PAUL RETHERFORD
MORTGAGE COMPANY: x Not Applicable
Name:
Address: 1402 HARTMAN RD
Address:
City: FORTPIERCE State: FL
Zip: 34947 Phone: 772-224-9826
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 wuI autnonze the erma nuiuer to uwiu ure wuJcLL bu uUaurc
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The f r oing instru ent was acknowledged before me
this day of I A%� YrA y
(Name of person acknowledging )
(Signature of Notary Public- tAtryof Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014
S
Signature of Contractor/License Holder
STATE OF FLORIDA do -,COUNTY OF L�! l�il_
The forgoing instrufnent was acknowledged before me
this 3) day of 20 M by
fzcbw M t l iacni
(Name of person acknowledging)
(Signature of Notary Publitj State of Florida )
Personally Known V110OR Produced Identification
Type of Identification Produced
Commission No.
(Seal)
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