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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: oL� `�� Permit Number:
- :I RtCEI' o 1017
Y
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
PERMIT APPLICATION FOR: Dock/Seawall
PROPOSED IMPROVEMENT LOCATION:
Address: 3254 DOCKAGE WAY
Legal Description: WIDE WATERS S/D LOT 7 (OR 3928-2283)
Property Tax ID#: 4436-510-0011-000-7 Lot No.7
Site Plan Name: WIDE WATERS Block No.
Project Name: DE LA ROSA DOCK ADDITIONS
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK_
CONSTRUCT A DOCK ADDITION AND INSTALL A BOAT LIFT
BOAT LIFT ELECTRIC TO BE APPLIED FOR UNDER SEPARATE PERMIT APPLICATION
CONSTRUCTION INFORMATION:
Additional workto (e Performed under this permit—check a apply:
�HVAC �J Gas Tank ❑Gas Piping Shutters 0 Windows/Doors
aElectric ❑ Plumbing Sprinklers 0 Generator 11 Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ O I yU Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameMaite De La Rosa Name: 1 L
Address:3254 DOCKAGE WAY Company: TREASURE COAST BARGE INC
City: PALM CITY State:FL Address: 1200 SE CUTOFF ROAD
Zip Code: 34990 Fax: City: STUART State:FL
Phone No.954-446-3780 Zip Code: 34994 Fax: (772)221-1611
E-Mail:sold@agentpuig.com Phone No. (772)201-9777
Fill in fee simple Title Holder on next page( if different E-Mail: JERNER@BELLSOUTH.NET
from the Owner listed above) State or County License: 20077
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: PAUL WELCH Name:
Address:1984 SW BILTMORE ST#114 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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencirig work or recording our Notice of Commencement. 1
("'U A �%4JU
Signature o Owner/Agent/Lessee Signature of Contractor icense Holder
STATE OF FLORIIXA STATE OF FLORIDA
COUNTY OF /�DL�i}i�' COUNTY OF
The f oing instru nt was acknowledged before me The f oi�igQir}stru ent w acknowledge"fore me
this V day of 20,lVby this ay of 20 y
(Av i ,
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Not ry Public-State of Florida ) Signature of Notary Pic-State FI
Personally Known, ��� f�SP�NIV Identifi atian Personally Known OR Produced Identification
Type of Identificbr4'Fir (X Type of Identification roduced
24,�o�ipF• '
Commission NQ_ §eal) Commission No. (Seal)
#GG D5 645
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Revised 07/f4.1'buc ut\de. ��°���` My Commission FF 079827
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