HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBY
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - Permit Number:
RECEIVED
Building Permit Application FEB 0 8 2018
Planning and Development Services
Building and Code Regulation DivisionT, [-Ysie County, permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Dock/Seawall
I PROPOSED IMPROVEMENT LOCATION: I I
Address:
Legal Description: NETTLES ISLAND INC, A CONDO -SECTION II PARCEL 1270 AND PRO-RATA SHARE IN COMMON ELEMENTS (OR 1484-2670 ; 2057-2902 ; 2081-131 ,135)
Property Tax ID #: 4502-501-1457-000-6
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
12M.",10
Remove/replace a ne ded dock boards and frame damaged by stor� 1�� e•� o�•�cI/L°P
1 S `f -r' 11 �� L >(`os s e�, �'- �., ` --�5 X t� d r%w4qo,f A C
CONSTRUCTION INFORMATION:
itiona wor to e ne orme under this permit— check all apply:
F]HVAC I_1 Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
0 Electric Plumbing Sprinklers Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: --7
Cost of Construction: $ ! s—o
S.Ftj. of First Floor:
Utilities: Sewer OSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: j
Company -5
Address: t'l
r S
City. b-e n � � G't State:
Zip Code: Fax:
City: lJ R
Stat
Phone No. -711 Z Z-
Zip Code:
Fax:
E-Mail: O vQ
Phone N —
27
Fill in fee simple Title Holder on ext page (if different
E-Mail: r e 0 r` Id
St Ira %. /11
from the Owner listed above)
State or County License:
M ri::?i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
NGINEER• _
DESIGNEMJ
Name: I C'
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
_P
Address:
City: Po
Zip: Phone ?'jj_ — ?
Stater
fs c = ?YSF ,E
City: State:
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 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
commer�cine work cwrecording your Notice of Commencement.
ature of Owner/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License
STATE OF FLORID I STATE OF FLORI )A
COUNTY OF /' GyC�/: COUNTY OF
The foM, instru ent was acknowledged before me
this 7 day of LA,4 c/ 20_1eby
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No. L I'
KONRATH
# 0GO60206
iary 05, 2021
The forgoing insu ent was acknowledged before me
this day of 20xby
Name of perso aking statement
Personally Known OR Produced Identification
Type of Identification
Produced
ature o Public- of Florida
A
Commission No. �? LE KONRAI
= MY coM ISSION # GG060
,efEXPIRES January 05, 202
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DATE
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DATE
`1�
COMPLETED
1
_f�'�
Rev. 8/2/17