HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED_
Date: T_ �1
Permit Number:
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 Residential X
fPERMIT APPLICATION FOR: Boat lift
PROPOSED IMPROVEMENT.LOCATION
Address: 318 Holly Avenue, Port St Lucie, FL 34952
Legal Description: River Park-Unit 2 BLK 19 LOT 20(MAP 34/22N)(OR 3604-1434)
I
Property Tax ID#; 3419=51040251=.000�5 Lot No.20
Site Plan Name: Block No. 19
Project Name: Thorson Lift
Setbacks Front Back: Right Side: Left Side:
ii
II DETAILED DESCRIPTION OF WORK.
`I I
II install (4) Lift Pilings; Install Lift
II
CO NSTRU CTIO NI N FO RMATIO N
Additional work to be nertormed under this permit—check all t at apply:
IIHVAC Gas Tank —]Gas Piping. _Shutters Q Windows/Doors
0 Electric F-1 Plumbing Sprinklers []Generator Roof Roof pitch
(. Total Sq. Ft of Construction: INq Sq. Ft.of First Flog:
I Cost of Construction:$ 2,000.00 Utilities: Sewer OSeptic Building Height: . 1
I
II OWNER/LESSEE: ,CONTRACTOR:
Name Darren Thorson Name: Dale Gasparik
Address:318 Holly Avenue Company: LD Contracting
City: Port St Lucie State:FL Address: 486 High Point Court
Zip Code: 34952 Fax: City: Melbourne State:FL
Phone No.(772)361-2920 Zip Code: 32901 Fax:
E-Mail:dthorson@gmail.com Phone No. 772-924-7244
Fill in fee simple Title Holder on next page(if different E-Mail: reginahellberg@gmail.com
from the Owner listed above) State or County License: CBC059-269
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Paulwelch Name:
Address:1984 SE Biltmore Terrace Address:
City: Port St Lucie State: FL City: State:
Zip: 34984 Phone: (772)785-9888 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 he first inspection. If you intend to obtain financing, consult with lender or an attorney before
comrrVencing work or recording our Notice of Commencement.
s
Signatd a of O ner/Lessee/Contractor as Agent for Owner Signa e f on ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie COUN OF St Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this It day of 7e jyuw 20 j�by this JV'day of -F-b/U.pr�/ 20 -(?-by
Dale Gaspark 1 Dale Gasparik
(Name of person acknowledging) (Name of person acknowled ing)
(Si a re of Notary P lic-State of Florida) (Sign of Notary P lic-State of Florida)
Personally Known I Personally Known0f3 RefuPf+dtltff
Type of Identifica r r eootary Pubik State of Florida Type of Identificati Vcechoory Public State of Florida
U911111 Milberg P,eglrla Hallberg
c` My Commission 00996712 � +i My trJr11P118911� 09q�712
Commission No. pfF o4 s^x free 05F25/ 81) Commission No. p. Iron o5�x5t a1)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW R VIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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xtsz'.i<rYs+uu '':Vv u4Y ."n'�'*nna. .� .: '�'.�s.s�. �'hi
4 '. {t{` ,7.4 a t^S�,a.
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�C----?---- �'',sa�,`17r�`��.x� ON
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Paul Welch Name:
Address:1984 SE Biltmore Terrace Address:
City: Port St Lucie State: FL City: State:
Zip: M84 Phone: y72)78r,-988e Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 he first inspection. If you intend to obtain financing, consult with lender or an attorney before
comnYbricing work or recording our Notice of Commencement.
s
Signat re of O ner/Lessee/Contractor as Agent for Owner Signa e f on ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFstLude COON OFstLude
The forZoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L_day of �k6rmq 20 p_by this 1%f�day of _6)114Nr / .20 ('2 by
Dale Gasparik 1 Dale Gasparik
(Name of person acknowledging) (Name of persjac;kn:owledd ing)
(Si a re of Notary P lic-State of Florida) (Sign of Notary P lic-State of Florida)
Personally Knowt
I Personally Known dFtL�tl�Itl.Etat4fl6dtiib
Type of Identifica .eplotary Public state of Florida Type of Identificati edNntc+r Public ate of Florida
1� a �` Regina Hallborg
if My Commission 00996712 v� < My Commmic p9 �12
Commission No. off' expire,o6fR5r�e81) Commission No. 4 Iroans�xg a�
Revised 07/15/2014 O2-- oy
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW 2REJVIEW RE IEW REVIEW)
DATE 1 1 v�' 1 ?/
COMPLETE J
INITIALS