HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED -FOR APPLICATION TO BE ACCEPTED
bate-�\m1 �� Permit Number:
RECEIVED
Building Permit Applicatio OCT Is 2018
Planning and Development Services ST. Lucie County, Per
Building and Code Regulation Division
2300 Virginia Avenug, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Docll WA
N�E®
PROPOSED IMPROVEMENT LOCATION:
Address: 1123 NETTLES BLVD
NETTLES ISLAND INC, A CONDO -SECTION 11 PARCEL 1123 AND PRO-RATA SHARE IN COMMON ELEMENTS
Legal Description: .
Property Tax ID #: 450?-501-1310-000-4 Lot No. 1123
Site Plan Name: Block No. -
Proiect Name: VAN LOAN DOCK REPLACEMENT
Back: Right Side: /0.1 k Left Side: 10
DETAILEDDESCRIPTION OF WORK: I
CONSTRUCT AN 8' X 20' MARGINAL DOCK. NO ELECTRIC
CONSTROCTION INFORMATION:
Ad Itll na wor to e e orme under this permit — c ec a app y:
❑_ HVAC Gas Tank Gas Piping 1:1^shutters FlWindow5/Doors
❑_ Electric ❑_ Plumbing Sprinklers Generator ❑_ Roof Roof pitch
Total Sq. Ft of Construction: S .Tt. of First Floor:
Cost of Construction: $ �, Utilities: _ Sewer n Septic Building Height:
II s
OWNER/LESSEE:
CONTRACTOR:
Name
Addres
City:
Zip Code:
Phone
E-Mail:
Fill in fee
from the
THOMAS VAN LOAN
Name: WMI&OW A 9 4160 tdt,
1123 NETTLES BLVD
Company: TREASURE COAST BARGE, INC
Address: 1200 SE CUTOFF ROAD
City: STUART State: FL
Zip Code: 34994 Fax:
Phone No. 772-201-9777
l-s
� ENSEN BEACH State:F�
,34957 Fax:
No.516-697-5008
vanloantom@yahoo.com
simple Title Holder.on next page (if different
Owner listed ;above)
E-Mail: JERNER@BELLSOUTH.NET
State or County License: 20077
it value of construction is.5Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: PAUL WELCH, INC
_
Name:
Address: 1984 BILTMORE DR #114
Address:
City: I PORT ST LUCIE State: FL
City: State:
Zip: 84982 Phone 772-785-9888
Zip: Phone:
FEE SI�VIPLE
TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name
Name:
Addrer�ss:
Address:
City:
City:
Phone:
I
Zip: Phone:
Zip:
DWNER/ 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
WARM i NG 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 I SiVnature of
STATE OF UGMA
COUNTY OF %-,i0.Ss0.v.
The forgoing instrument was acknowledged before me
thisa 8' day of 2012' by
U 0x-1 \—oar.
Name of perso making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Ae`ida )
NicoWIR- eroux
Commission No.pl LE(oaWe,, 14ifNow York
j No. 01 LE6224249
Qualified in Nassau County_
Holder
STATE OF FLORIDA W ��
COUNTY OF
The L5i
nstr m_ en w s ac nowledg fore me
this day of 1 20 by
IAIfl__I - _I / _ - f), __
Name oT ers aking statement
Personally Kno OR Produced Identification
Type gf4d@ntification '\
re of Nbfaryl*blic- State of Florida )
Commission
LUCY JULIANO
Notary Public - State of Florida
[nmmission M GG 101693
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA ��'`' Nab l VE
COUNTER REVIEW REVIEW REVIEW REVIE E IEW REVIEW
DATE
RECEIVED
DATE
COIVIPLET
Rev. 8/2117