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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date:" �' %J' 7 Permit Number: / 7/0 ' L?
RECEIVE
Building Permit Application OCT 11 2017
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: Boat lift Q
PROPOSED IMPROVEMENT LOCATION:
Address: 10751 S. Ocean Dr., #A8, Jensen Beach, FL 34957
Legal Description: 1137 41 from sw cor sec 12-37-41 run n 89 deg 55 min 14 sec E alg S sec Li 774.47 ft to GI A1A
th n 23 deg 49 min 31 sec w aig sd cA 2921.33 ft th s56 deg 10 min 29 see w290.01 ft, th n 87 deg 33 min 17 sec w 393.12 fl, th s 8g deg 57 min 13 sec w 133.4ft th s Do dog. eta
Property Tax ID #: 451131100120003 Lot No.A8
Site Plan Name: Moser Boat Lift/Dock Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: .
DETAILED DESCRIPTION OF WORK:
Install 1 ea. 4 piling 16k Hurrican Boat Lift and a 4'x14' access dock
CONSTRUCTION INFORMATION:
Additional work to be performed
11HVAC
under this permit — check
all
apply:
Shutters
a Windows/Doors
Gas Tank
Gas Piping
_
Electric QPlumbing
❑Sprinklers
❑.Generator
❑ Roof Roof pitch
Total Sq. Ft of Construction: _
/0 000
S . Ft. of First Floor:
0 0
Height:
Cost of Construction: $
, - Utilities:
Sewer
Septic
Building
OWNER/LESSEE:
CONTRACTOR:
NameThomas Moser
Name: R. Williams
Address: 10751 S. Ocean Dr., LotA8
Company: Wilco Construction, Inc.
City: Jensen Beach State:FL
Address: 10751 Orange Ave.
Zip Code: 34957 Fax:
City: Ft. Pierce State: FL
Phone No.7724852076
Zip Code: 34945 Fax: 7724606929
E-Mail:tom@cashservicestc:com
Phone No. 7724606928
Fill in fee simple Title Holder on next page ( If different
E-Mail: wilcoinc@bellsouth.het
from the Owner listed above)
State or County License ":'CC /31/S/OZ (D 29//S
� . 11 if value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
I4
SUPPLEMENTALCONST�RUCTIO�NLI'ENIAININFR�M'ATION:rp5."
r
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:
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 1 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 ra 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
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of ntractor/License Holder
STATE OF FLORIDA�
��
STATE OF FLORIDA � 1 r, n C� J
�'X
COUNTY OF
l
COUNTY
The f oing instrun
this day of
as acknowledged before me
20� by
The for oing instru t as acknowledged before me
this �% day of 20�Qby
42l,Ul1 �;ar�s
AT U Jkt0 MA
Name of ers
making statement
Name of person making statement
Personally Known o� OR Produced Identification
Personally Known
OR Produced identification
_I
Type of Identification
Type of Identification
Produced
01
Produced
(Signature of Notary Pu
c, ,,o F on A N FIIZGERALD
(Signature of No .. tc- a i LD
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Commission No.
t?- MYCOMMISSIONNFF077529
= . a,' EXPIMPOecember 17, 2017
MY COMMISSION B FF 077529
* '� EXPIRES: Decemf�g��I)?017.
Commission No. : �:o:
'.,$F i , W Bonded Thru Notary Public Underwriters
�j ��,:•`' Bonded Thru Notary Pubic Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17