HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A'\ 1, X1 Permit Number: �1 (bon
RECEIVED AUG 011017
Building Permit Application
Planning and Development Services
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: Dock/
PE20POSEQ I11%IPROVEMENT LCf`CATI>QN
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Address: 10851 S. OCEAN DRIVE, LOT 133, JENSEN BEACH, FL 34957
Legal Description: WINDMILL VILLAGE BY -THE -SEA CONDOMINIUM NO 1 UNIT 133 AND PRO-RATA SHARE IN COMMON ELEMENTS
Property Tax ID #: 11 b 1 -'� d- O 1 y O• d0- j
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
INSTALL1 PC. 4' X 20' DOCK ( 80 S Q. FT. )
Lot No. 133
Block No.
GINNERLESSwEE�
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CON`CRACl"O'R# 5"
Name WILLIAM BREMIGEN
Name: ROBERT WILLIAMS
Company: WILCO CONSTRUCTION INC
Address: 10851 S. OCEAN DRIVE, LOT 133
Address: 10751 ORANGE AVE
City: JENSEN BEACH State: FL
Zip Code: 34957 Fax:
City: FORT PIERCE State: FL
Phone No. 518-560-9234
Zip Code: 34945 Fax: 772-460-6929
E-Mail: NIA
Phone No. 772-460-6928
E-Mail: WILCOINC@BELLSOUTH.NET
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: SCC131151026 29115
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name: DANIEL PAUL RETHERFORD
Address: 1402 HARTMAN ROAD
City: FORT PIERCE State: FL
Zip: 34947 Phone: 772-224-9826
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
c .
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Signature of Contractor/License Holder
STATE OF FLORIDA C� �� STATE OF COUNTY OFORIDA
COUNTY OF J lM.
The fo oing instru ent was acknowledge !fore me The for ing instru ent was acknowledge Rfore me
this day of 20 by thismday of 20 by
(Name of person acknowledging )
�LLo�_w
(Signature of Notary jPub�lic- State of Florida )
Personally Known e/ OR Produced Identification
Type of Identification Produced
K. wi i, ia m,�
(Name of person acknow dging )
(Signature of Notary Public- Sta of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. ,ter"imp(Se�)NNFITZGERALD (Commission No.
.; .: Y COMMISSION 8 FF 077529
EXPIRES: December 17, 2017.,
Revised 07/15/2014
(_,)eBAWN FITZGERALD
MY COMMISSION 4 FF 077529
EXPIRES: December 17, 2017.
REVIEWS
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
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INITIALS
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