HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY aF
• _ = St. Lucie County p 4Ap cif`-%
Building Permit Application st,�tn '16'1a�
Planning and Development Services 100, 0 9
de
Building
Vi ginia Aovenue9P' Fort eulationrce FL 34982 ivision c 2300
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Boat lift & Dock III
111{ 1 VJI IIVI.111Vv-LIvl"IMA "WIC 1:1V1.V.
Address: 10751 S OCEAN DR LOTA-5, JENSEN BEACH
Legal Description: SEE ATTACHED
Property Tax ID #: 4511-311-0009-000-9 Lot No.
Site Plan Name: LELIEVRE Block No.
Project Name: LELIEVRE- DOCK & BL
Setbacks Front�Back: Right Side: --LeftSide:--_�
DETAILED,OESCRIP.TIONOFWORK'
1. FURNISH AND INSTALL 1 PC. 50 SQ FT. +/- DOCK
2. FURNISH AND INSTALL 1 PC. 12,000 LB CAPACITY BOAT LIFT
[CONSTRUCTION: INFORMATION:
ttiona wor to e e orme under tispermit—check all apply:
❑HVAC Gas Tank 1❑Gas Piping _Shutters ❑ Windows/Doors
Electric 0 Plumbing []Sprinklers Generator ❑ Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 13,000.00
S Ft. of First Floor: _
Utilities:n Sewer []Septic
Building Height:
OWNER/LESSEE:' -
CONTRACTOR:
Name LELIEVRE, NEAL & CATHY
Name: ROBERT WILLIAMS
Address:303 CAYUGA LANE
Company: WILCO CONSTRUCTION INC
City: JACKSON State: NJ
Zip Code: 08527 Fax: NIA
Phone No.732-600-7119
Address: 10751 ORANGEAVE
City: FORT PIERCE State: FL
Zip Code: 34945 Fax: 772-460-6929
Phone No. 772-460-6928
E-Mail: NIA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: WILCOINC@BELLSOUTH.NET
State or County License: SCC131151026 29115
If value of construction is $2500 or more, a RECORDED Notice
is required.
SUPPLEMENTAL CONSTRUCTIONLIEN LAW IN
Name: DANIEL PAUL RETHERFORD
1402 HARTMAN RD
City: FORTMERCE State: FL
Zip: 34947 Phone: 772-224-9826
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name: --
Address:
City:
Zip: Phone:
ON:
MORTGAGE COMPANY:
Name:
x Not Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
x Not Applicable
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count yY 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
commencing work or recording Your Notice of Commencement.
Signature of Own Contractor as Agent for Owner
STATEOFFLORIDAa L i Co COUNTY OF
The foJJB8,oing instru{p �en�t was acknowledge fort! me
this O day of 20 by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida)
Personally Known _ZOR Produced Identification
Type of Identification Produced
Commission No.
162348
-`;< F. °;' Bonded Ttw
Revised 07/15/2014 =
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5
Signature of Co r Icense Holder
STATE OF FLORIDA
�� I L
COUNTY OF -1
The for oing instr� Ment as ack1 nowledge�qdbefore me
this May of 20 L by
Mill (Iams
(Name of person acknowledging)
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
MY COMMISSION # GG 162348
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS