HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� ((``��,+ /I
Date: Permit Number: 1 -7 VQj 0 19T
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 -
0 .
PROPOSED IMPROVEMENT LOCATION:
Address: 7001 S INDIAN RIVER DR, FT PIERCE, FL 34982
Legal Description: OLMSTEAD PLACE S/D LOT 6(OR 3893-649)
7001 S INDIAN RIVER DR, FT PIERCE, FL 34982
Property Tax ID#: 3412-502-0007-0004 Lot No. 6
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: RightSide: Left-Side:
F6ETAILED DESCRIPTION OF WORK:
INSTALL DOCK ADDITION & BOAT LIFT
rot Alec'-if,iG t"O � � e GanrneC-+ e � �sfin5 Ga�K
poc.AJems- or d �d i �,cLt PGA Cii/'Cuj¢ Q'S
CONSTRUCTION INFORMATION:
Additional work to e nertormed under this permit—check a apply:
11HVAC0 Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
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Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 20,000.00 Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name DIANE PHILLIPS Name: JOY S YANCY
Address:7001 S INDIAN RIVER DR Company: SUMMERLIN'S MARINE CONSTRUCTION, LLC
City: FT PIERCE State: FL Address: 200 NACO RD, SUITE C
Zip Code: 34982 Fax: City: FT PIERCE State: FL
Phone No.912-429-1442 Zip Code: 34946 Fax: 772464-7470
E-Mail: TINAACORD890@COMCAST;NET Phone No. 772-464-6090
Fill in fee simple Title Holder on next page(if different E-Mail: SUMMERLINSMARINECONSTRUCTION@GMAIL.COM
from the Owner listed above) State or County License: 24217
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION'LIEN LAW I'NFORMATI,ON: '
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name. OWL[ b_>J_Gh 0 .1f>G Name: HI-TIDE BOAT LIFTS
Add re s: ICl S(.KD (SI f nNr)r,P-- S+ # II Address: 4050SELVITZRD
City: Sn . e' State: FL City: FTPIERCE State: FL
Zip:-._ 3LILIRL4 Phone Zip: 34991 Phone:772461-4660
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: 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 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
comme ork or recording our Notice of Commencement.
Signature of Owner/Lessee/Con rotor as Agent for Owner Signat�re f Co or trac License o der
STATE OF FLORIDA STAT OF FLORIDA
COUNTY OF LoG I-Q� COUNTY OF sTLU=-
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The forgoing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this day of SW} 201 by this day of S 2AD 20 °]�// by j
-Ph) JOY SYANCY
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced ��. /�J�/ I/eff C fl�S Q— Produced
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SI nature Nota c_t q F (Signature o ota P �1
( .g _ N#FF912939 ry ,,ti+ �s R :HE__
TERCommission No. q ` "'TE$('6tgllst 25,2019 Commission No. FF91293 MY CO � 912939
EXPI ES Au ,2019FwwamD0:
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REV EW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED (�
DATE
COMPLETED
Rev.8/2/17
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