HomeMy WebLinkAboutTODD ROY NOTARIZED PERMIT APPLICATIONAll APPLICABLE INF MUST BE CoMPLETED F R APPlICATioW T BE ACCEPTED
Date:01/13/2 12 Permit Num ber:
l LiO[! : :’'C
Bu!!d!ng Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FI 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residentia! XCommercia!
PERMIT APPLICATION FOR:Boatlift
PROPOSED !MPROVEMENT LOCAnON:
Address: 8650 s Ocean Dr #1105 Jensen Beach,FL 34957 Slip #11
Property Tax ID #: 3534-501-0059-000-5 Lot No.
Site Plan Name:
Project Name: -
Block No.
DETAILED DESCRIPTION OF WORK:
Installation of 24,OOOIb capacity, 8 post, yach lift
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Gas Piping
— Sprinklers
Mechanical GasTank Shutters
Electric Plumbing Generat
Windows/Doors Pond
or Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 41,008
Sq. Ft. of First Floor: _
Sewer —SepticUtilities:Building Height:
OWNER/IESSEE:CONTRACTOR:
NameTodd Roy , Denise Roy
Address:411 Walnut St.
City: Green Cove Springs
Zip Code: 32043
Phone No. 305-985-7000
E-Maii:James@jamesr y.c m
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
State: FL
Fax:
Narne:Adam Trenter
Company:Atlantic Seawall & Dock Co
Address:6352 sw Key Deer Lane
City: Palm City
Zip Code: 34990
Phone No 772-263-1712
E-Maìiadam@seawallcontractor.com
state or County LicenseCBCI 258639
Sta
Fax·.
te: FL
If value of construrtion 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 CONSTRUCT!ON UEN LAW !NFORMAT! N:
DES GNER/ENG!NEER:
Name:
Address:
c!t :
Not App!Icab!e NotApp!!cab!eMGRTGAGE CGMPANY:
Name:
Address:
City:State:State:
Phone Phone:z!p:Zip:
,NotApp!lcab!eNot App!!cab!6FEE S!MPLE Τ!ΤΙΕ HGIDER:
Name:
Address:
Clt :
Zip:Phone:
BONDING COMPANY:
Name:
Address:
City;
Phone:Zip:
OWNER/ CONTRACTOR AFFIDVIT: App cat^ n 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.
S .l^c!e.Count .make no representation tha ¡s granting a permit ~111 a^t^orize the^ermit holde to build the subject structurewhich is in_ on ¡ct wlth.any applicable Horpe Ownęrs Assoç.atlon .rules, bylaws pr and covenants thạt may. restrict or prohibit suchstructure. Please consult with our Home Owners Association and reviéw your deed for any restrictions Which may a^ply.
In consideration of the granting of this requested permit, I do tiereby 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-resldentla l 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.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lejhder or an attorney before commencing work or reco
gyour Jotice of Commencement.
Signatur of Contractor/license Holder
ằ
of owner/ lessee/Contractor as Agent for OwnerSigna- re
STA-OF FLORIDA STATE OF FLOR!^ COUNTY OF
~7~ to (or affirmed) and subscribed before me of ~7~ to (or affirmed) and subscribed before me of
^^ysical Presence or-Online NotarizationthisZ^dayof^^ ^^^,202^by_ 7 3 Pre|::;^ (^ine NotarizationV y dav 0fn^ 2^d 202^bythis
Nam of person making statement.Name of person making statement.
Personally Known / OR Produced Identific^tionu..,.
Type of Identification //
-
Personally Known
Type of Identification
1 p^y^ed-
OR Produced Idealif'ÉoaIÁ
/jA
.. *.
signature of Notary Public- State of llao'da.) ^ !
lĩếi .Commission NoI ~~/. Commission No
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
Lt\J\l\N
PLANS VEGETATION
ί\Ι\Ι
SEA TURTLE
^ \ \1
MANGROVE
RÎ\I\I
DATE
RECEIVED
DATE
COMPLETED
-