HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `/��I �
Date: I \I aqI 11 Permit Number: A `l - 35
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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
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Address: Sr 44k 4.A (4,6 645 ilk Tny 'i-0fo
Legal Description: >`I GZ'
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Property Tax ID #: 3 cf 22 cS OO - 00 6 9 - pptC A Lot No.
Site Plan Name: Block No.
Project Name: AA /JS'a" -
Setbacks Front N /r- Back: AdA— Right Side: NI' Left Side:
DETAILED DESCRIPTION OFWORK:
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CONSTRUCTION
INFORMATION:
itiona wor to
e e orme under tispermit-check
all apply:
11HVAC
Gas Tank Gas Piping
_ Shutters
❑ Windows/Doors
11 Electric
0 Plumbing Sprinklers
11 Generator
E]Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction:
$ /a 3l.49 Utilities:
Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameLt(J56G�,
LAt�IriilL�
Name: MICHAELGOODWIN
Address: OS 4f
lL17.A/OI/ f
Company: JENSEN BEACH ALUMINUM
City: cogg
Zip Code: k/01
Phone No.� rglN)
State: 14
Fax:
8B2^ 7C9 9
Address: 1720 NW FEDERAL HWY
City: STUART State: FL
Zip Code: 34994 Fax: 692-9744
Phone No. 692-0090
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: MICHAELLGOODWIN@YAHOO.COM
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:
Name: 7M10 A16441s
_ Not Applicable
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MORTGAGE COMPANY: _ Not Applicable
Name:
Address: / Ca
Address:
City: f
Zip: 3351YU Phone: ;
State: PL
-/0!/Q
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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 yourjpaying twice for
improvements to your prope otce of Commencement must be recorded an/ed on the jobsite
before th� in�peci n. intend to obtain financing, consult v�i#F1ndsf orney before
commeri nghv2 ec vdur Notice of Commencement. /
s
Signs ure of Owner Le ee/� ntractor as Agent for Owner ature o Contractor icense Holder
STATE OF FLORID, STATE aA v� STATE OF FLORI21i „ ,/1
COUNTY OF //L COUNTY OF �YLG�+' �
The f r ing mstru a wa ac11knlIPwle ged b fore me
this day of = 3y
(Name of person acknowledging )
(Signature oUotary Public- State of olorida ),
Personally Known � OR Produced Identification
Type of Identification XL__
Commission No.lti/2,3512— (Seal)
01 Florida
Revised 07/15/2014
, 235102
The �f7oreoing instrument was acknowledged before me
this/i/ day of Q,D 20 by
(Name of person acknowledging )
(Signature of o ary Public -St a of Flor' a )
Personally Known OR Produced Identification
Type of Identiffcatio Produced
No. C%_SS-1VZ
State of Ffoiide
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
2�� I
INITIALS