HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u q
Date: 1170111-1 Permit Number:
- RECEIVTH JAN 27M17
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1.553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Boat lift 1 Djl✓C' El
PROPOSED IMPROVEMENT LOCATIO'N:'
Address: 10701 S. Ocean Dr., Lot 647,Jensen Beach, FL 34957
Legal Description: Venture Out-Section C-Lot 48(OR 1304-39:2831-2236)
Property Tax ID#: 451180500480000 Lot No fie_ Lttf
Site Plan Name: Lembach Boat Lift/Dock Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1 . Inns+al1 tL 12' 10 rig 3up+z margino'l dcXX
2. Insial I a lo-000 I b. SrJO+
CONSTRUCTION INFORMATION:
Additionalwork to be ertormed under this permit—check all appy:
HVAC Gas Tank DGas Piping Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: (� S Ft.of First Floor:
Cost of Construction:$ %1 0yo ' GO Utilities:In Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name William Lembach Name: R.Williams
Address:10701 S. Ocean Dr., Lot 647 Company: Wilco Construction, Inc.
City: Jensen Beach State:FL Address: 10751 Orange Ave.
Zip Code: 34957 Fax: City: Ft. Pierce State:FL
Phone No.7725795801 Zip Code: 34945 Fax:—
E-Mail:b.lembach332@gmail.com Phone No. 7724606928
Fill in fee simple Title Holder on next page(if different E-Mail: wilcoinc@bellsouth.net
from the Owner listed above) State or County License: SCG 13 5 0
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIENLAW INFORMATION':
DESIGNER/ENGINEE Not A plic ble MORTGAGE COMPANY: _Not Applicable
Name: Name:
Addre,�5: Address:
City:/-OY--f l•PJ'_f State: City: State:
ZipL�L/-1 Phone: —7--721 O 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 lender or an attorney before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA C�-. L J
COUNTY OF COUNTY OF VI
The f oing instrum nt was acknowledge fore me The forgoing instru eenAt was acknowledged before me
this ay of 20 y thi�day of�'a.n ,20 t� by
I/u1 L�1. ag-IS 2wl� O
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi -State of Florida) ( l ✓ul
gnature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. "'rPm• RGERALD
�;w�'oy•, DAWN FI GE LD ``E= MY COMMISSIONFF 077529
cin•' ;, ' *. *__
:, ;; MY COMMISSION t FF 077529 :,Q= EXPIRES:December 17,2017.
tionaea I hru Wary Public UndefOrers
1�'•• �Q•'
Revised 07/15/ Bonded Thru Notary public Underwriters —
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIE REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE 2,h
INITIALS