HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. rr --
Date: IP0 Permit Number: to LJ
�Bwilding Permit Application
Planning and Development Services �tY nt
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: Boat lift & DOCK
PROPOSED, I:fV1PROVEMENT LOCATION
Address: 415 NETTLES BLVD, JENSEN BEACH, FL 34957
Legal Description: NETTLES ISLAND INC, A CONDO -SECTION II PARCEL 415 ANDPRO-RATA SHARE IN COMMON ELEMENTS (OR 3742-1562)
Property Tax ID #: 4502-501-0601-000-4
Site Plan Name: BUSLON
Project Name: BUSLON - BOAT LIFT
Setbacks Front Back _
Right Side: Left Side:
Lot No.
Block No.
D'ETAIfL`ED,DrESCRIPTION OF WORK `I
FURNISH AND INSTALL A 72 SQ. FT. DOCK EXTENSION & REPLACE THE EXISTING
BOAT LIFT
CQN'S,TRUCT 1110W4 IVFORIVIATION
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-A-Oitional work to je nej r orme un
�HVAC Gas Tank
ert is permit —check
❑Gas Piping
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apply:
In
a Windows/Doors
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—Shutters,
11 Electric 0 Plumbing
Sprinklers
ElGenerator
EIRoof Roof pitch
Total Sq. Ft of Construction:
15,000.00
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Ft. of First Floor:
El
Cost of Construction: $
Utilities:'n
Sewer Septic
Building Height:
OWNER/LESSEE -
_. _. _ _
CONTRACTOR
Name BENNY BUSLON
Address: 415 NETTLES BLVD
Name: ROBERT WILLIAMS
Company: WILCO CONSTRUCTION INC
Address: 10751 ORANGE AVE
City: JENSEN BEACH State: FL
Zip Code: 34957 Fax: NIA
Phone No. 219-779-4580
City: FORT PIERCE State: FL
Zip Code: 34945 Fax: 772-460-6929
Phone No. 772-460-6928
E-Mail: NIA
Fill in flee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: WILCOINC@BELLSOUTH.NET
State or County License: SCC131151026 29115
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S000LEMENTAL-CONSTRUCTION LIE N'LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
X Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
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
commencing work or recording your Notice of Commencement.
s
Fe of O essee/Contractor as Agent for Owner nature o ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f rgoing instru e t was acknowledg d efore me The forgoing instrument was acknowledged fore me
this T day of 20by this day of �) V(�-- , 20 by
PA
200 A6
(Name of person acknowledging) (Name of person acknowledging)
D%u q� -
(Signature of Notary Public State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
DAWN FITZGERALD
EXPIRES: December 17, 2021
Revised 0 7 / 15Q` Bonded Thru Notary Public Underwriters
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
DAWN FITZGERALD
MY COMMISSION # GG 162348
EXPIRES: December 17, 2021
Bonded Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS