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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l 1 ZD Permit Number:
r
FRECEIVEOBuilding Permit ApplicatioN 0 �c,Planning and Development Services 2 0Building and Code Regulation Division County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial _A/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Iy 1 y 2 S CSC tnl T.*z
Legal Description:
A-r&A NTL S cck-,op TL-4o6 A dff 1 f LJ v 44 w
Property Tax ID#: ro 2 — 9J Z — cb 7c— —CIDJ — Lot No.
Site Plan Name: APeZiA Block No.
Project Name: Ainl.e-
,Setbacks Front Back: ~F' Right Side: Left Side:
DETAILED DESCRIPTION-OF WORK :
a
CONSTRUCTION INFORM°ATION
Additional workto be nertormed under this permit—c ec a tat appy:
HVAC Gas Tank Gas Piping 11 Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers MGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ 30__>_z1Utilities:Sewer Septic Building Height:
OWNER/LESS' E'E:',' CONTRACTOR:
Name Name: MICHAEL GOODWIN
Address: 15-0 N/ Sw /r_b lid Cid' Company: JENSEN BEACH ALUMINUM
City: o" 'A-m i State:TL Address: 1720 NW FEDERAL HWY
Zip Code: '33196 ; Fax: City: STUART State.FL
Phone No. Zip Code: 34994 Fax: 692-9744
E-Mail: Phone No. 692-0090
Fill in fee simple Title Holder on next page(if different. E-Mail: MICHAELLGOODWIN@YAHOO.COM
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 MORTGAGE COMPANY: _Not Applicable
Name: 60tvft►J SIG Name:
Address: qjQS=&OrW- e--1E Address:
City: L-n- State:r-l—, 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 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
Lucie Count Amendments.
accordance with the roved tans the Florida Building Codes and St. uc y
in acco pp p g
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wal ,signs,screen rooms and accessory uses to another non residential.use
WARNING TO OWNER:Your fai re to c Notice of Commencement yr ult in yo r ing twice for;
improvements to your prope Ic Commencement must be eco da d o d on the jobsite
before the first i �e, do . If o In n obtain financing, consult with der n torney before
commencin ork or In r tice of Commencement.
s
Signature bf Owner essee/Contract r as Agent for Owner Signature/of Contractor/Li se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF MGC n COUNTY OF mQqr�-iY-%
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of -CTC-ty\ 20 F> by this � day of 20 by
t
(Name of person acknowledging) (Name of person acknowledging)
V( k —"ox
(Sig at re oftary.Publi/c-State of FI rida) (Sig at re of tary Public-State ofFlorida)
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ea ommission No.C CMZ pv�lic State of Florida
�e. Notary ubllc State of Florida $ Angela Staples
'Angela Staples
n GG 235102 My commission GG 235102
(0771PA 44P22002
a tid Expires 07/0412022
Revised 07/15/2014
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS