HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
RM BY RECEIVED
St. Lucie County
— � '-=---'---- 14 1019
Y;4
Building Permit Application Permitting 2019
artment
Planning and Development Services St. Lucie county
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Dock/Seawall
PROPOSED IMPROVEMENT LOCATION: _
Address: 3062 NW RADCLIFFE WAY PALM CITY FL 34990
Legal Description: RIVERBEND (PB 67-36)- LOT 17 (OR 4028-2025)
Property Tax ID #: 4425-703-0022-000-5 Lot No.17
Site Plan Name: Block No.
Project Name: LADD DOCK
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ° , . III
CONSTRUCT A 147' X 4' ACCESS PIER AND 10' X 16' TERMINUS
- I ,
CONSTRUCTION INFORMATION:
Additional work to eperforme under t—checkispermit a y: app
�HVAC Gas Tank ❑Gas Piping _Shutters El
Windows/Doors
IectriC-- ^ ZJ Plumbing• e []Sprinklers ElGenerator 0 Roof Roof pitch
Total Sq, Ft of;Constrliction:'r's.?� tt SQ. Ft. of First Floor:
.....
Cost of.Construction,'$' �?7.67& �yc) Utilities: 11Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name MICHAELLADD
Name: --
Address: 3062 NW RADCLIFFE WAY
Company:' -'TREASURE COAST,- BARGE, INC
City: PALM CITY State: PALM
Zip Code: 34990 Fax:
Phone No. 561-301-4205
'Mdress: 1200 SE CUTOFF ROAD
City: STUART State: FL
Zip Code: 34994 Fax:
Phone No. 772-201-9777
E-Mail: mladd@agilis.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: 20077
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION -
DESIGN EQENGI NEER: _ 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:
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, co It with lend e an attorney before
commencingwork or recordingour Notice of Comme
Signature of Owner Lessee/Contractor as Agent for
Signature of r/License Holder
STATE OF FLORIDA� 1 y� I—
C�y
STATE OF FLORIDA
COUNTY OF II-'}}V�` l3f l
COUNTYOF �YI1�
The forgoing instrunn was acknowledged before me
The forgoirig instru entrt� wa nowledgeedd before me
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this 3 dayofv 20\ by
this 2a day of b
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1A \ "� t So h�-�
`20�
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M(� f ec"Cr UIC,
Name of person ing statement
Name of perso making statement
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Ide ification
Type of Identification
LUOaCR15TOrOR0
Produced
Produced =.4„...
� ••- °uhif: •Stan of Florida
commbtIon M GG 219262
my Comm, Explrei May 17, 2022
\ Bonded through National Notary Ann.
(Signature if Notary Publ'e-5tat
(Signature of NotJ4 Public -State of Florida )
Commission No.G
JAMIEACCORTO- =
C0MA11600B13175398
Commission No. (Seal)
EXPIRES: FEB 16;2022?
Bonded lhmuphlststate 'Insunanse
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17