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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:Jcpua• 0 lr
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Building Permit Application ii
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
PERMIT APPLICATION FOR: Window/door
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PROPOSED IMPROt%EMENT LOCATIQN. :
Address: 409 E Coconut Ave. Port Saint Lucie, FL 34957 I
Legal Description: RIVER PARK-UNIT 2-BLK 1 LOT 17(MAP 34/22N)(OR 3558-1039)
Property Tax ID#: 3419-510-0017-000-3Lot No.17
Site Plan Name: I; Block No. 1
Project Name:
Landrith,#9197858/9244780
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Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION QF WORK„
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Replacing 1;,windows and 1 door size for size on a modular home.
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GNSTR;UCTION IN=I=ORMATION: ,,
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Additional work to be nertormed under tispermit—c ec a appy: //I,,
HVAC Gas Tank Gas Piping _Shutters YI . Windows/Doors
Electric E] Plumbing OSprinklers 11 Generator Ehoof -
Total Sq. Ft of Construction: S . Ft. of First Floor:
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Cost of Construction:$ Utilities. _Sewer O Septic Building Height:
CIWNERAESSEE _ . .....
Name Susan Landrith Name: Boysie Ramdial
Address:409 E Coconut Ave. Company: The Home Depot,At Home Services
City: Port Saint Lucie State:FL Address: 674 S Military Trail
Zip Code: 34957 Fax: City: Deerfield Beach State:FL
Phone No.(954)448-4682 Zip Code: 33442 1, Fax:
E-Mail: Phone No. (954)379- 1500 1
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: l;
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL,CONSTRUCTION LIEN�LAW INFORMATION � � � ���' � � ��,� � '�` - E` �'
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:',: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: .1
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: I
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 thepermit 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':froom 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. l'
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Signature of Owner/Agent/Lessee Signature of Contractor/Licens 6 Holder
STATE OF FLORI A``,, _ STATE OF FLORIDA
COUNTY OF AV,&- COUNTY OF La i
The forgoing instrument was acknowledged before The forgoing instrurrnt was acknowledged before me
me this O-( day of _,,VV ' 20 16 by this 11-I day of Krtt 20 16 by
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Boysie R mdial 1 Boysle Ramdial
(Nam of rson ackn led Ing) (Name o pe son ackno ging1,f X,
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(STRUe of Nota bl -State of Florida) (Sight re of Not Public-State of Florida)
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Personally Known x OR Produced Identification Personally Known x Ol f Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. �F�7o93y (Seal)
Amber FI&*er Amber Flanker
NOTARy pi Igo I'
STATE OF FLORIDA NOTARY PUBLIC
Revised 07/15/2014 Cam*FF970934 STATE OF FLORIDA
%4c�1sJ1FM_- 1 . CMM*FF970934
1111.91 V ti
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION I SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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