HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO RF ACCEPTED
Date:
Permit Number: W,O ®/
Building Permit Application � � � IV
Planning and Development Services ,tanent
Building and Code Regulation Division Commercial Residentfa-l"<X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Dock and Dock
PROPOSED`IMPROVEMENT LOCATION
:._. :.. .�.,.... ... ..,.;,./ .. 1. ... �:.,1. .. ..... ..,.
Address: 9895 S. Indian. River Drive, Fort Pierce, FL 34982
262
Property Tax ID -223-0002-000-2 Lot No.
Site Plan Name: 9895 S. Indian River Dr. Block No.
Project Name: Deck and Dock
Construction of Deck, Stairs and Dock at site per drawings atgtached to application
New Electrical Meter no Second Electrical Meterno
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 15,000.00
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
_ Roof Pitch
Utilities: —Sewer _Septic Building Height:
�OVI/NER/LESSEE f k7 a q
CONTRACTOR
Name Maurice Splain & Elizabeth Stolkowski JTWRS
Name:
Address: 9895 S> Indian River Dri
Company:
City: Fort Pierce State: _
Zip Code: 34982 Fax:
Phone No.216-269-7850
Address:
City: State:
Zip Code: Fax:
Phone No'.
E-Mail:dsplain@nriinstitute.edu
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
VO UC uLIu„�LJ uS-.iull ib 4auu ur rnure, a nrLuKutu ivotice or commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
N`' C �y.. 1j ' �( � IA
SlJ'PPLEMENTA�UCONSTRIJCTIONYLIENLg11V INFORMP►TION�rjF
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City.
City. a
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 failu a to Record a Notice of Commencement may result in paying twice for
improvements to your prope . A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on th 'obsite before the first inspection. If you intend to obtain financing, consult
th lender or.an attorney bef commencing work or recording our Notice of Commencement.
Signature of ne Les a/Contractor as ent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed befor me of
Sworn to (or affirmed) and subscribed before me of
Physical Pr ence or Online NQtarization
Physical Presence or Online Notarization
thisoD9�-day o 2020 by
this day of 2020 by
1 AA D1,CA
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identifications
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
�
Produced
�__Vnl\vw M_
A_P�
ignature of Nolar
(Signature of Notary Public- State of Florida )
Commission No.
F I ,A4
�'•)OQ�60�
Commission No. (Seal)
EXPIRES: Dewmber20, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20