HomeMy WebLinkAboutBUILDING PERMITAH. A1111LICA11LU MUST BE COMPLETED FOR APPLICATION TO BE ACCEP1 ED
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Date: b vim/ Permit Number:
1 4—
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578 Commercial _ Residential X
PERMIT APPLICATION FOR' DocicW"Pweplil-
PROPOSED IMPROVEMENT LOCATION:
Address: 902 JACKSON WAY, FORT PIERCE
Legal Description: COASTAL COVES -UNIT 1-LOT 15 (OFF 3975-798)
Property Tax ID #: 1423-802-0017-000-6 Lot No.
Site Plan Name: FASNACHT Blocl(No.
Project Name: FASNACHT-DOCK
Setbacks Front Back: Right Side: Left Side:
L)L I Al LLD DESCRIPTION OF WORK:
SUPPLEMENTAL CONSTRUCTION
LIEN LAW
INFORMATION.
DESIGNER/ENGINEER: Not
Name: DANIEL PAUL RETHERFORD
Applicable
MORTGAGE COMPANY:
Name:
X Not Applicable
Address: 1402 HARTMAN RD
Address:
City: FORT PIERCE
Zip: 34947 Phone: 772-224t-9826
State: FL
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: x Not
Name:
Applicable
BONDING COMPANY:
Name:
Not Applicable
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.
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Signatfire of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
S T Aii r OF F IVORIDA pI STATE OF FLORIDA � , ,
C��)&_ N u V OF� �t1C� COUNTY OF �,U.C,�
The for oing instru ent was acknowledge fore me The forgoing instrum nt was acknowledged before me
this day of 20by this day of 20 by
�- W 1 L In Iyu
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida) ( ignature of Notary Public- State of Florida
/)
Personally Known " OR Produced Identification Personally Know OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission —::,, — Itt Commission No. DAWN ��Qnd
,,�s� .. N Hl"iZG D'. �a
=� MY COMMISSION # GG 162346 '_, , : MY COMMISSION M
'�eBonded Thn� Notary PublicUnderNritersBonded 7hni Notary Pu
Revised 07
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