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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A)Q
Date: Permit Number: I ' V
RiEcE®
Building Permit Application
Planning and Development Services Building and Code Regulation Division 2300 VirginioAvenue, Fort Pierce FL 34982 r1le11t
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial �R, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
RROPOSED;IMPROVEMENT LOCAT(,ON<<f,
_
Address: lodoo S .0005N -De 4 304 i "�i=AK�►J ���- IstLucie C®uni
Legal Description:
M.I-� IM tl&►y(A'YL 1Wit )mil d' ntil►tioa �
Property Tax ID #: 1I(b2, -701 — oniLot No.
Site Plan Name: SS Block No.
Project Name: ��✓5
Setbacks Front w D< Back: N IY Right Side: F' Left Side:_
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DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
Additionalwork to e nertormed under this permit - check a that apply:
❑HVAC0 Gas Tank ' ❑Gas Piping L.CJ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ � 00 Utilities: _ Sewer ❑ Septic Building Height:
OW,N ER/LESSEE ,.,..
CONTRACTO.R:.. n o u
Name
Name: MICHAEL GOODWIN
Address:_S O cerMj�W !ra1
Company: JENSEN BEACH ALUMINUM
City: 1ig,,A ekf 1SG��&— State: fti
Zip Code: '?i j Fax:
Phone No. "1?� �c�� — �?i7is
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.
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SUPPLEMENTAL CONSTRUCTION LIEN•LAW INFORMATION.
DESIGNER/ENGINEER: _
Name: yGo`LfhA4 W11*0
Not Applicable
& .A
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: (fW4A MA')Li/viVV
Sr2�-r 5U� f-E W
Address:
City:
Zip: Phone:
State: T%L
- 3
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 pool's, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failureAo Record a Notice of Commencement may result in your paying twice for
improvements to your pro r ,,- Notice of Commencement must be orded a d posted on the jobsite
before the first inspe ti If intend to obtain financing, consult it len r ran attorney before
commencirxw' lrk7e r r ; your Notice of Commencement.
Signature of Owner
as Agent for Owner
nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF — I COUNTY OF
The forgo' g�instrument was acknowledged efore me The forgot g instrument was acknowledged before me
this(=,— y of 4 Z4Z 20/'by this ay of � 20 byto
(Name of person acknowledging) (Name of person acknowledging )
(Signature o Notary Public- State of Florida) (Signature o o ary Public- State of Florida )
Personally Known �,OR Produced Identification Personally Known �—,-' OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.
(Seal)
Commission No.
(Seal)
F; R. °va %
--- —
ANN M• GAUMOND
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ANN M. GAU�90ND
MY COMMISSION # FF 173907
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EXPIRES: December 7, 2018
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Revised 07/15/2014' �' '°`
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EXPIRES December 7, 2018
Bonded Thro Notary Public Underwriters
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Bonded Thor Kota Public Underwriters
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