HomeMy WebLinkAboutBUILDING PERMIIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L� L `N � � SCANIN Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772y462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Boat lift
Address: 114 QUEEN ANN CT FORT PIERCE FL
Legal Description: QUEENS COVE -UNIT 2- BLK 24
mmercial Residential X
E(OR 3683-2336)
Property Tax ID #: 1414-702-0031-000-5
Site Plan Name: BLANCHARD
Project Name: BLANCHARD
Setbacks Front ID I A Back: \ Right Side Left Side:
FURNISH AND INSTALL 1 PC. 1,500 LB CAPAC
LIFT TO MOUNT TO EXISTING DOCK PILING
iaitionai worK to oe nerrormea
11HVAC Gas Tank
FlElectric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3,500.00
r this permit — cnecK a
Piping
SPINNER MODEL BOAT LIFT
Lot No.
Block No.
a ppiy:
Shutters ❑ Windows/Doors
Sprinklers LJ Generator - Roof
Sq. Ft. of First Floor: _
Utilities: Sewer OSeptic
Building Height:
Roof pitch
L 'V�
01 VNER� LESSEE 3 � a.
�.�:. .� _t:
S� � 1 � � 1' c �..
CONTRA fOR:
�•. �
i
Name ROLAND BLANCHARD
Name: ROBERT WILLIAMS
Address:114 QUEEN ANN CT
Company: WILCO CONSTRUCTION INC
City: FT PIERCE State: FL
Address. 10751 ORANGE AVE
Zip Code: 34949 Fax:
City: FORT PIERCE
State: FL
Phone No. 772-448-8780
Zip Code: 34945 Fax: 772-460-6929
E-Mail: N/A
Phone No. 772-460-6928
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
if value of construction is $2500 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: 1402 HARTMAN RD !
Address:
City: FORT PIERCE State: FL
City: State:
Zip: 34947 Phone: 772-224-9826
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 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 aAotice 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 your Notice of',Commencement. _
1.11 L____1 s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of C ntractor/License Holder
STATE OF FLORIDA _(- STATE OF FLORIDAC�LJ
COUNTY OF s I uCJc� COUNTY OF JJ
The torgoing instrument was acknowledged before me The rgoing instru ent,�^�as acknowledged before me
thi day of" � 20 �by this day of L( 20 N� by
K—t� 1/U,1 l i �'1C VA L l(Iq ms
(Name of person acknowledging) (Name of person acknowledging)
'Tk
Vag
(Signature of Notary Public- State of Florida) (Signature of Notary Public State of Florida )
Personally Know OR Produced Identification Personally KnoW4___ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ,'< +kv'' DAW(CHWERAW I� I Commission No.
W COMMISSION # GG 162348
Bonded Thnu Notary Public Undennitem
Revised 07/1
— DAWN FfFZGEitALD
W COMMISSION # GG 162346
Bonded Thiu Notary Public Undemiters
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COMPLETE
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