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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ((�
Date: 8/8/2019 Permit Number:
Building Permit Application
iPlanning and Development Services
Building and Code Regulation Division
1 2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x -
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT'LOCATION:
Address: 9628 Enclave Circle, Port St Lucie, FL 34986
Legal Description: Enclave at the Reserve
Property Tax ID #: 3322-800-0011-600/4
Site Plan Name:
Project Name:
I
Lot No. 8
Block No.
CONSTRUCTION INFORMATION
k ,Additional work to be nertormed under this permit — Check . a apply:
❑✓ HVAC _ Gas Tank Gas Piping _ Shutters a Windows/Doors
Electric 0 Plumbing F]Sprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ $4750.00 Utilities- Septic Building Height:
01NNER/LESSEE
C.ONTRACTOR:. •
Name Ann and Doug Goschke
Name:. Keith'Thorripson ;.
Company: AC. Keith Inc.
Address: 9628 Enclave Circle
City: Port St Lucie State: FL
Address:
Zip Code: 34986 Fax: n/a
City: Port -St -Lucie State. -
Phone No.772-201-7364 '
Zip Coder 34953 Fax: n/a
E-Mail: ann@dragonflyprop.com
Phone No.- 7712-519-1351
Fill in fee simple Title Holder on next page (if different
E-Mail: ackeith1@att.net
from the Owner listed above)
State or County License: CAC1813976
if value of construction is $2500 or more, -a RECORDED Notice of Commencement is required.
SU.P.PLEIVIENTAL 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:
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, consult with lender or aryattorney before
commencipg,work or recording your Notice of Commenceme%.,, / , ,
r/
Signa ire of Owner Less ontr for ent for Owner
Signature of Contr ctor/Li nse Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF �� _ L_,L Lc , e
COUNTY OF t5T - LAC J �
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
(—iu —
this day of At & g 1 20 (al by
this 3 day of 20J_q by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Produced 1 lc(Ucl- �v,yrmSL�C Ste.
Type of Identification
Produced T—l0r)-'r0\P,
(Signature of Nota U tGn,4Xate of F oridaD72
(Signature of Notary P
=a° �Y P`;` BELIND� W. S
* • Notary - S
�5@�)Commission
; o<PR` P°B�-., BIND W. SUTCLIFFE
No. ;�» 1
Commission No. _. ._
Commission #
. Nota M Ic State of Florida
My Comm. Expire
gN9r Commission # FF 956234"
My Comm. Expires Apr 17, 2020
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Rev. 8/2/17