HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
oU
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: finger piers
Address: Pelican Pointe Drive, Jensen Beach, FL 34957
Property Tax ID #.. N/A
Site Plan Name: Pelican Pointe West
Project Name: dock addition
Dock with 5 finger slips
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit check all that apply:
Mechanical ^ Gas Tank _ Gas Piping _ Shutters
Electric ^ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Lot No.
Block No.
— Windows/Doors Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities. _ Sewer ` Septic Building Height:
Name Brian Dernb, Pres(dent, Pelican Pointe Homeowners West Assoc
Address: 1111 SE Federal Highway, #100
City: Stuart State:
Zip Code: 34994 Fax:
Phone No. 772-408-7538
E-M a i I: lisak@advpropmgt.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Cebrone Atkins
Company: Samson Marine Construction
Address: 402 Concha Dr
City. Sebastian State: FI
Zip Code: 32958 Fax:
Phone No 772-713-7803
F-Mail Inquiries@ samsonmarineconstruction.ro
State or County License CGC1517960
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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: Brian Demic
—
Name:
Address: 7659 Pelican Poinle Drive
Address: --
City: Jensen Beach
City:
Zip: 34957 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
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
cie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
ith I der or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owne
ig u e of Contractor/License Holder
STATE OF FLORPA
COUNTY OF i
STATE OF FLORIDA
Al 0'
l (
COUNTY OF G' Itll c.s,
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
_71 - Physical Presence or Online Notarization
this ��" day of ACV (,M\� 2020 by
`• Physical Presence or Online Notarization
this � day of ►.�o�r�,n�r' 2020 by
f
)-Ory'_ !WK, s
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Prodw,ed _
Prod ced
I,.
C
(Signature of Notary Public atjQ�'e>k loricla } JSA SIERRA
kb!IC Stite of F16rl
ignature of Notary Public t of HiliVipiad Gayle Ruesga
t: `` Notary -
Commission No. r_ mission R HH 002119
r s y m. ExplreS Au1131, 2G
NOTARY PUBLIC
mmission No. STATERWIPLORIDA
11 ••,,
�. /ended through Nitionii Notary Ass
-
1'1 mac. COmmtk GG172569
Expires 1 4
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
V.