HomeMy WebLinkAboutBuilding Permit Application a j
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 rz. 7. Permit Number:
RECEIVED
Building Permit Application MAR /2 2017
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 Residential X
PERMIT APPLICATION FOR: Boat lift
°PRC►POSED IMPROVEM.E`NT:LOCATIOIV '
Address: 12436 Harbour Ridge Blvd„ Palm City, FL 34990(Slip 26) 60 Q,wf— RI!)epur 6LUO
'Legal Desc�i t--R4verzide-V#lage•L4nit-1-3-(OF:888=752;3247=284) SLJf��,(o 'I'et. Ak GI`�
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Property Tax ID#: 4426-51 3-000-7 �4J01.6- (D O a - 0 007 0 0C)�/ Lot No.
Site Plan Name: Block No.
Project Name: O'Hare Residence
Setbacks Front Back: Right Side: Left Side:
DETAILED`DESCRlPT10"N,.OF WORK'.'
Instal'Patlift in community marina
?fit K
"CONSTRUCTI`ON JNF RMATION
Additional work to be performed under this permit c ec a t appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric Plumbing Sprinklers Generator g Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ u-0 Utilities. Sewer ElSeptic Building Height:
OWNER/LESSEE CONTRACTOR.
Name-T&Mys hib.-P-Jrl Name: 64t-Ac Tn P Lk>jop
Address: 1?A3(n@51.V Company: M&1-k1NeKJp C >1.65"j"•
City: -ML,,!1, C-.-N State:_VA, Address: PD 50X V138
Zip Code: Z2A'1'10 Fax: City:'M?-T SI �L .—Y FJo State, �V
Phone No. 4-1 inm- Zip Code: 5'kl--1 '2 Fax:
E-Mail: Phone No.lr7�Z� 7 1^^3 —01 E>e!>
Fill in fee simple Title Holder on next page(if different E-Mail YY1LA1r�Lt�'td-lw���1 Soy-�'1'1•n
1
from the Owner listed above) State or County License: C�C�C. i25331"�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENIAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: 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 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 rney before
commencingwork or recordingour Notice of Commencement
CL O l-� s
ature of Owner/Lessee/(Mntracto A for vomer, Signature of Contra se Holder
CD STATE OF-Fm@RiB 1 «,b; ^�a STATE OF FLORIDA r
COUNTY OF AA aor COUNTY OF >i\Y
' O
�e The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
di F, this day of 20 Mby this day of 20 by
CD
CD
(Name of person acknowledging) (Na a of person acknowledgi g)
"kw_
(Signature of Notary Public-State 4-pleri'el (Sign ure of itotary Public-State of Floridal)
Personally Known t//' OR Produced Identification Personally Known '_� OR Produced Identification
Type of Identification Produced Type of Identificati n Produced
KI' MW
Commission No.7'S200O- _ eal)NObl 75= Commission o. o ��U�� YCHRISTI ECOP D
CQMMONWEA THOF ( fi. MY COMMISSION#FF948042
EXPIRES:JIM 05.2020
Revised 07/15/2014 QO 9111ISSIM WN&"MY 31! Bonded through 1st State Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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