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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED
BY
_ ___ -_ ___•__- _ -_ Building Permit Application St. Lucie County
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/Seawall
I PROPOSED IMPROVEMENT LOCATION: I
Address: 701 RAMIE COURT
Legal Description: RIVER PARK -UNIT 3- BILK 22 LOT 17(MAP 34/22S) (OR 4001-1271)
Property Tax ID #: 3419-515-0081-000-7
Site Plan Name:
Proiect Name: BLACK SEAWALL/ DOCK REPALACEMENT
Setbacks Front Back: Right Side: LeftSide:
Lot No.17
Block No. 22
DETAILED DESCRIPTION OF WORK: III
REPLACE A 225' +/- SEAWALL; REPLACE EXISTING DOCK & INSTALL A BOAT LIFT
CONSTRUCTION INFORMATION: III
ondi WOM io ue
HVAC
errurmeu unuer inns
Gas Tank []Gas
permit—cnecK all
Piping _Shutters
apply:
❑Windows/Doors
Electric
E] Plumbing
Sprinklers
Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $ ZDoIwo
S Ft. of First Floor:
UtilitiestSewer 0Septic
Building Height:
Roof pitch
OWNER/LESSEE:
CONTRACTOR:
Name KIRBY BLACK
Name: THOMAS FLYNN
Address: 701 RAMIE COURT
Company: THEW GROUP INC
City: PORT ST LUCIE State: FL
Zip Code: 34952 Fax:
Phone No. (954)336-0324
Address: 1409 SW ALBATROSS
City: PALM CITY State: FL
Zip Code: 34990 Fax:
Phone No. (772)220-1930
E-Mail: KIRBY@BLACKFIREPROTECTION.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: JERNER@BELLSOUTH.NET
State or County License: CGC1505177
If value of construction is $2soo or more, a RECORDED Notice of Commencement is required.
n
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
commencingwork or recordingour Notice of Commencement.
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Rev.8/2/17
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DESIGNER/ENGINEER: _Not Applicable
Name: PAUL WELCH. INC
MORTGAGE COMPANY:
Name:
_Not Applicable
Address: 1984 BILTMORE DR #114
Address:
City: PORT ST LUCIE State: FL
Zip: 34982 Phone 772-785-9888
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Signature Owner/ Lessee/Con ractor as Agent for Owner
i Lure Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 6TI LJGIe
COUNTY OF
The forgoing instrument was acknowledged before me
The for oing instru,(�'lent was acknowledge before me
this ��dayof s()Qt0(�(L ,20� by
this�dayof /f'I.R�( 201� by
Ki&r2Y (iLNciG
e-1�0.,As kYuti/
Name of person making statement
Jill
Name of perso making statement
Personally Known OR Produced Identification
PersonallyKnown OR Produced Identification
Type of Identification
Type of Identification
Produced II-L CJ- 1, u G
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Produced
Sig Lure f ary rF P b
(Signs of Notary State 9�(%AE
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Co mi55ionNo. : •= Nota jo-StateofFlorida
$� Comm ssion sFF 212473
Commission No..
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My Comm. Expires Jun 23, 20I9
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