HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t ,k. I q° p I Permit Number:
O `J Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: DOCK
PROPOSED IMPROVEMENT LOCATION:
Address: 11311 S INDIAN RIVER DR, FT PIERCE, FL 34982
Property Tax ID #. 3532-412-0001-020-1 Lot No. —
Site Plan Name: Block No.
Project Name: _
DETAILED DESCRIPTION OF WORK:
REPLACE DOCK
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 4 a 1 0 O 6. 0 C
OWNER/LESSEE:
Generator _ Roof
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
CONTRACTOR:
Pond
_ Pitch
NameGEORGE JUNO
Name:JOY S YANCY
Address:11311 S INDIAN RIVER DR
Company-SUMMERLIN'S MARINE
City: FT PIERCE State: _
Address:200 NACO RD #C
Zip Code: 34982 Fax:
City: FT PIERCE State: FL
Phone No.770-329-4985
Zip Code: 34946 Fax: 772-464-7470
E-Mail:GWJUNO AOL.COM
Phone N0772464-6090
Fill in fee simple Title Holder on next page ( if different
E-Mail SUMMERLINSMARINECONSTRUCTION@GMAIL.COM
from the Owner listed above)
State or County License24217
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: P_t1 C.-\ M0_'(i<
Address: Ci -e- G'aVs
City: li4 "P i -e_PC-Q_ State: FL
Zip: �3�-J 1. S 6 Phone __1-7;7 QCo_7 . 137T—
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
_ Not Applicable
State:
Not Applicable
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 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 the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an att_9rney before co-mmencing work or recording our Notice of Commencement.
Signature of i4trlactor - or�-'i,]wner Builer as applicable
STATE OF O IDQ f JJ
COUNTY , i- L-C.d C, l `�
Swor to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this 1 LPday of 120alby
o S C G
Name of person making stateme t.
st
Personally Known W OR Produced Identification
Type of Ideentification Produced
n p j
(Signature of No6ky Public- State of Florida
/� /� n Notary Public State of Florida
Commission No.G�'330� 1 (Seal) Ginger P Hester
+� �+� My Commission GG 33025g
�r� per Expires 08/25/2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
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DATE
RECEIVED
DATE
COMPLETED