HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o1.b rJ Permit Number:
RECEIVED JW2 5 20b
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: To Select from dropbox, click arrow at the end of line W i 5
PROPOSED IMPROVEMENT LOCATION.
Address: 218 SE Camino St. Port Saint Lucie,FL 34952
Legal Description: River Park Unit 3 Blk 28 Lot 33 (Map 34/22S) (OR 3292-410: 3566-587)
Property Tax ID#: 3419-515-0222-000-8 Lot No. 33
Site Plan Name: -Block No. 28
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF�WORK:
0,
Replace 6 windows size for size. e-1 l
CONSTRUCTION INFORMATION:
Additionalworkto eeorme under this permit—c ec a appy:
HVAC El Gas Tank E]Gas Piping Shutters a Windows/Doors
11 Electric ❑ Plumbing U Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 5203 Utilities:Sewer FISeptic Building Height:
OWNER LESSEE. CONTRACTOR:'"
Name Daniel Roznowski Name: Boysie Ramdial.
Address: 218 SE Camino St Company: The Home Depot At Home Services
City: Port Saint Lucie State: FL Address: 674 Military Trail
Zip Code: 34952 Fax: City: Deerfield Beach State:FL
Phone No. Zip Code: 33442 Fax:
E-Mail: Phone No. (974)379-1500
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CRC046858
If value of construction is$2500 or more,a RECORDED Notice of Commencement.is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION' `
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
commencing work or recording our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signatur of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie County COUNTY OF St Lucie County
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this '--L-dayof -,S6 OC--' 20 15-by o this ZZ day of 7SZ>0F_- 20 15 by
Boysie Ramdial 1 Boysie Rambial
(Name of person acknowledging) (Name of person acknowledging)
�c �rZ�`�S �c��:
( ' t re of Notary Publi tate of Florida) (Signature of Notary��®R
ate of Florida )
Personal) Known �OR Produced Identification Personally Known Produced Identification
Y
Type of Identification Produced Type of Identification Produced
.Commission No. (Seal) Commission No. (Seal)
Erick Pe Dlaa Erick p®01106
NOTARY FPSUC NOTARY PU
Revised 07/15/20STATE OF FLORIDA " STATE OF FLORIDA
.�� Coiii",FF163545; Cornm10 FF1635 5
Exp es El � Expires 12161.2018;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SE,4'TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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