HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO �MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A I" Permit Number:
1.
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 51/
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR'QPOSED IMPRCbVEM�ENT LOCATION:
Address: I ? ��-1 S 4i eivL�a�. �2 $ yo I
Legal Description:
/ n� pi LYl�, (�� ✓c7L LA7�Or/V f� /� t.OG zl UNi? 41.01 A^O Go 4 A.%A., 2k7"&z-T1
Property Tax ID #: — upa — 6oCD /z_ Lot No.
Site Plan Name: -T-9 /PS Block No.
Project Name:
PS
Setbacks Front_!�,#_ Back: Right Side: �' Left Side:
DETAILED DESCRIPTION".OF�WORK• °'
11HVAC
❑ Electric
0 j9&W1,0V6 S
&-X 151rA_J6
"Shutters
❑OSprinklers
Plumbing 1i Generator 11 Roof Roof pitch
-- /Uv^/.7�-f#cq-
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities:CnSewer 0Septic
eWindows/Doors
Building Height:
0WN`ER/LESSEE " -
CONTRACTOR:
Name
Name: MICHAEL GOODWIN
Company: JENSEN BEACH ALUMINUM
Address: l Zis 9 S _25k1`14o- AL ^//L !/0/
City: F-r Pf61_%,C_e cl0/ State: _
Zip Code: PK5C7 Fax:
Phone No. .26--
Address: 1720 NW FEDERAL HWY
City: STUART State: FL
Zip Code: 34994 Fax: 692-9744
Phone No. 692-0090
E-Mail: MICHAELLGOODWIN@YAHOO.COM
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CGC 1508437
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name: 8(iv$90 6 ay;16'E e,
MORTGAGE COMPANY:. _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address: yZ&S 60-reCOUAr
City: y6m o State:
Zip: Phone: 202 _ $w
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fence$, walls, signs, screen rooms and accessory use to anotl er non-residential use
WARNING TO OWNER: Your faily
o Record a Notice of Commencemen ay
esult h yo r aying twice for
'
improvement
pr p rty/
'Notice of Commencement must b rec
d cl ed on the jobsite
before the 'rst ii
Fit
y,
intend to obtain financing, consul with
d or ttorney before
comma In wo
c d"
our Notice of Commencement.
ee/Contractor as Agent for Own
Sig re of Owner/Le
Signature o Contract
icense Holder
STATE OF FLORIj�Q►a
A _��
STATE OF FLOR�,Q�,/
,�
COUNTY OF
j'
�]'�
COUNTY OF I l b
'V
^v
1y'
The forgoing instrument was a acnow-dge6b,
fore me
this' day of20
_ftW 0_U0
(N me of person acknowledging)
(Signature Uf Notary Public -State oVFlorida )
Personally Known _ OR Produced Identification
Type of Identification Produced
Commission N
Revised 07/15/20
The forgo' instru1;ent was acknowl dged before me
this ( ay of �tJ 20 by
M
(Na�person acknowledging )
(Signature bJ Notary Public- State old Florida)
Personally Known OR Produced Identification
uc Type of Identificatio Proded
State of Florida S I Commission No.
My Commission GG 235102
(4&6V Public State of Florida
KArolmmis ion GG 235102
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