HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED { r
Date: ��!� Permit Number: 11 I i da`P3
. RECEIVED
Building Permit Applicatq n
Planning and Development Services NOV 13 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Pj,s�i i Department
PERMIT APPLICATION FOR: Other
PROPOSED IMPROVEMENT;LOCATI 1N
Address: 65 AQUA RA DR, JENSEN BEACH FL 34957
Legal Description: RIVER WATCH BLK 3 LOT 3 (OR 3613-1661)
Ar-la// ZSL. F7; Uf `yam
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CONSTRUCTION ,IN FORM>ATION
Additional work to e e orme under this permit — check a apply:
❑HVAC E] Gas Tank Gas Piping _ Shutters Windows Doors
❑ P g ❑ /
Electric ❑ Plumbing Sprinklers ❑ Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 5,000.00
S Ft. of First Floor: _
Utilities:cnSewer 0Septic
Building Height:
°01NNaER/LESSEE
CONTRACTOR
Name GLENN EBERLE
Name: ROBERT WILLIAMS
Address: 65 AQUA RA DR
Company: WILCO CONSTRUCTION INC
City: JENSEN BEACH State: FL
Address: 10751 ORANGE AVE
Zip Code: 34957 Fax: NIA
City: FORT PIERCE State: FL
Phone No. 561-248-1637
Zip Code: 34945 Fax: 772-460-6929
Phone No. 772-460-6928
E-Mail: NIA
Fill in fee simple Title Holder on next page ( if different
E-Mail: WILCOINC@BELLSOUTH.NET
from the Owner listed above)
State or County License: SCC131151026 29115
IT value oT construction is $ZSUU or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION'.-,
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: x— Not Applicable
Name: DANIEL PAUL RETHERFORD
Name:
Address:
City: State:
Address: 1402 HARTMAN RD
City: FORT PIERCE State: FL
Zip: 34947 Phone: 772-224-9826
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is g-ranting 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 vour Notice of Commencement.
s
Signa ut re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instruw4V4111&-l'
as acknowledge efore me The for oing instru e t as a know ledg d before me
this day of 20 LLby this ay of 20 by
�lll�LtCQI' r kas
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Public- tate of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
I—
dl��WLL I
(Signature of Notary Publ' - State of Florida )
Personally Known ,�// OR Produced Identification
Type of Identification Produced
DAW1kMERALD Commission N '.r Pi9•. DAWN FITZGER4Pa1)
MY COMh # FF 077529 =;.t : MY COMMISSION # FF 077529
EXPIRES: December 17, 2017 EXPIRES: December 17, 2017.
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