HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ Permit Number:
RECEIVED AUG 17 2017
Building Permit Application
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: Siding
PRQPOSED 1MPROUEMENT LOCATION u
Address: 12150 Riverbend RD Port St Lucie, FL 34984
Legal Description. BAY ST LUCIE LOT 17 (SUBJ TO ESMT TO C AND SFFCD) (MAP 44/22N) (OR 3137-1318: 3467-151, 1910; 3592-980)
Property Tax ID #: 4422-502-0020-000-5
Site Plan Name:
Project Name: Wolff- Siding
Setbacks Front Back:
Right Side: Left Side:
Lot No. 17
Block No.
[.DETAILED DESCRIPTION, OF WORK; ,, a w:
Install James Hardie Plank Siding
Q1NNE;R%LESSEE:..
CONTRACTOR:
Name Michael Wolff, Barbara J Wolff, Jeffrey Lackey (TR)
Address: 12150 Riverbend RD
Name: Michael Holeman
Company: Holeman Inc
City: Port St Lucie State: FL
Zip Code: 34984 Fax:
Phone No. 317 435 0812
Address: 212 N US Hwy 1 #17
City: Tequesta State: FL
Zip Code: 33469 Fax: 561 743 3747
Phone No. 561 743 0687
E-Mail: MBWolffl @hotmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Mike@Holemaninc.com
State or County License: CBC 1250217
If value of construction is $2500 or more, a RECORDED Notice of Commencement is regwrea.
'A
SUPpLEiVIENTAI. L1EN lA1N 1NFQRMAT1tlN
,CONSTRUCTIQN
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 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
commen in w or recooing your Notice of Commencement.
.3`
s
Signature of Owner/Le s e/Contract r Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA.,joWt_
FLORIDA e \ t ea Cv
COUNTY OF t,c B��/%
COUNTY OF
The forgoing instrument was acknowledged before me
this�°�day of / U6,..,� 20 / 7by
The forgoing instrument was acknowledged before me
this —14day of Ny(AuSA , 20 (1 by
(Name of person acknowledging)
(Name of person acknowledging)
a�V u Q N�
gn e o otary Pu c- State of Florida)
(Signature of Notary Public- State of Florida )
f
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced PG Ceryf4LXcjre
Type of Identification Produced
Y PVe Julio Vasq
ez
Commission No. t�Seal)
ommission No. , ��e a LANIE OUINN
State of FI
riva :-:� .`� ; Nbtary Public -State of Florida,
.
-'n'9f. SOP M
Revised 07/15/2014 s °F _ rnmil eion Nc�. F 103713 ; ;;<«�:, y Comm Expires May 17. 2020
V"� Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS