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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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. Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID #: 553.f
Site Plan Name: 1�r1Gt¢rJ
Project Name:
Setbacks Front Back
OHVAC 1-1 Gas Tank
11 Electric ElPlumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 30, 00
K)
)03v - cuo —d Lot No.
Block No.
Right Side: N 4- Left Side: N14-
unaer this permit— check all tha apply:
Gas Piping 11 Shutters
Sprinklers ❑ Generator
S�Ftj. of First Floor: _
> S� Utilities: Sewer Septic
Name Tl4oAMl-5 YG/G/
Address: Lgn—o
City: tdKat : &2wi
Zip Code: Fax:
Phone No. / 3�v —5'S?7
E-Mail:
Fill in fee simple Title Holder on next p;
from the Owner listed above)
-Windows/Doors
11 Roof Roof pitch
Building Height:
h/f Name: MICHAEL GOODWIN
%� Company: JENSEN BEACH ALUMINUM
_ State: _rf�f,, Address: 1720 NW FEDERAL HWY
City: STUART State: FL
Zip Code: 34994 Fax: 692-9744
Phone No. 692-0090
( if different 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.
DESIGNER/ENGINEER: Not Applicable
Name: Nl om ✓qa At.&M 1NNm � avtIr mil.
Address: S`Vy d M041A&A, SSThk /oi
City: !iA-2mA' State:
Zip: o 1 4 A Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
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 fare 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: Yo f ilu to Record a Notice of Commencement may result in your paying twice for
improvements to your pr y Notice of Commencement must be r rde/a�, os d on the jobsite
before th first insp ti y intend to obtain financing, consul lth ey�den torney before
Comm ci �pvork r c d' voUr Notice of Commencement. �//
r as Agent for Owner�<—T Signature, of trontractorMicense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFST COUNTYOF
The for o' instrument was acknowledged before me The forgooiU instrument was acknowledged before me
thi y of� Z2C,- , 20/ by this�`��y of A/-Uet7 , 20 Z by
(Name of person acknowledging) (Name of person acknowledging)
r
(Signature o otary Public- State of Florida )
Personally Known _� OR Produced Identification
Type of Identification Produced
Commission No.
M.GAUMOND
EXPIRES: December 7, 2022
Revised 07/15/201 aF�° BondedT6NotaryPublicUndernntem
(Signature f-Notary Public- State oM6rida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission No.
ANN M. GAUMOND
EXPIRES: December 7, 2022
Bonded Thor Notary Public Underwriters
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