HomeMy WebLinkAboutLake Manor - the dockAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Cate:
Permit Number:
4 LL uG("
0 ,F -
�`- Building Permit Application
Prannirg and Development Services
Baildin7 and Code Regulation Division Commercial _ Residential
2300 V rginia Avenue, Fort Pierce FL 34982
Plone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
VROFOSED IMPROVEMENT LOCATION:
Address 12� �Y,� w,. S2: or D•- fir• ..�..
L�CKa
- ;� -
Yr��.nc r �c «
,i �2 SU{�fL�ai�S iCi� (J Ci e0r1C i-P
-r
f2 c'.r�ciyZ,
Prq�ert• Tax ID #: r► I -I u s+
s r 5 -1
Lot No.
5ii'I�P1a`�N�me: c.x x� '.
+ Soak -,5
-our;p - -
Block No.
Prcgect Warne. c1
0 ck
DETAJLED DESCRIPTION OF WORK:
S -
W
ti rtin C .
t✓
4 L 2
New Ele:trical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Ad Jitiomal work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
El ?ctric _ Plumbing _ Sprinklers
Total Sq Ft of Construction:
Cosi of Construction: $ i
OWNER/LESSEE:
(Affidavit required)
Shutters _ Windows/Doors Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
NameL, Vu rA t7 - ,c=1..r,t(-
Ac dresss: I k I1 = F p �ti ro- I t. ' / oc
1
Ci-y: C vr.. r State: rt-
Zip Co le: 3`4, `1 cl L4 Fax:
PI•one No.r+tic,ra-F4 - J o. t } ri tµ5
E-- ha i 1: T e lk ,44 '. - i -1 r-i V
Fit in fie simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:ti►.�..� ��, ite�+, �►
Address:3�S
City: e �-� r• (�' e c� � State: P- -
Zip Code: ;'kcI �-► Fax: C>R i 11 � `i •czf
Ph,hToic-0 -tv �'loa - Yc . - S-3 3 3
E-Mail V� b 5-333
State or County License'
If value of construction 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.
SJPFLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
No m e:
Address:
C ty:.` State:
Z p: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
C ty:
Zip: Phone:__
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
Not Applicable i
State:
BONDING COMPANY: Not Applicable
Name:
Address:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I ce-tify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie :ounty makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whth 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 follo giving building permit applications are exempt from undergoing a full concurrency review: room additions,
accessor" structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNI NG 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 theJobsite 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.
u-e of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF i'v"\c r- A,
STorn tD (or affirmed) and subscribed before me of leff—Physical Presence or Online Notarization
th s to+' ` day of c.\ , 20� by
—� �-p
NE me cf person making statement.
PErsonzlly Known Cam- OR Produced Identification
Ty3e of Identification Produced_tL_kd.,r . _cc, " 73f .\AL_ 'tea
(S-gnatire of Notary Public- State of Florida )
;�;Y r;''•• KAREN CODERRE
Commission No.6-6 "i Y 1 l) 1 Ui. ` (Seal) � � '
; �: *, MY COMMISSION f! GG 981001
EXPIRES: April 23, 2024
Bonded Th. Notary Public Underwriters
FEVIEJVS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED