HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0- - 1,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4\� SCANNED Permit Number:
BY
St. Lucie County RECEIVED
0 im,
-sexall " 11 - P 18 ?,018
I BUilding Permit Application SE
Planning and Development Services -ST. Lucie_ ou�ty, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Fl. 34992
Phone: (772) 462-1553 Fax: (772) 462-IS78 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line - III
I PROPOSED IMPROVEMENT LUCAI IUN: - I III
Address: itt 57- S Q�a� -P& !i�VC,3L,4r.A±
Legal Description: , AILjLn,; a^-0-10 9L,06 61-2,-a 431-69 ppe. A"4
�IL. - - /, - - -, *?/ 4 — 40', C4 -I
Property Tax ID #: qj-d I goj - W L(I -
Site Plan Name: Tl-net4--
Project Name: Y, r7irtkL4.
Setbacks Fr
Back: —t4AW Right Side: PLA- Left Side:
[D TAILE13 OE RIPtIO'N,OF WORK"'-'
0P&7WA,6
NzeL 't
Lot No.
Block No.
CONSTRUCTION INFORMATION-'
Additional work to be nertormed unclerthis permit- cneck all [napp FV(
IJHVAC GasTank F]Gas Piping Shut ers LnS[ Windows/Doors
11 Electric Plumbing []Sprinklers Generator 1:1 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ )I[ Doc,'
S Ft of First Floor:
Utilities: Sewer OSeptic Building Height:
OWNER/LESSEE�
CONTRACTOR:
Name 14-t-crerli, IzAg6N
Name: MICHAEL GOODWIN
I
Address: 1c)(5-7, Qca-2�opz &I z -15
Company: JENSEN BEACH ALUMINUM
-T
City: Sli INtA+ State:
Zip Code: 3 L(q,�-2 Fax:
Phone No. qc�(-
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 ifdifferent
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 RECUKUhU Notice Or LOMmencemenx is requireu.
��L
ISLIPPLEMENTALCONSTRILIC17ION LIEN LAW,INFORMATION:
DESIGNER/ENGINEER: ble OR �GAGE COMPANY: Not Applicable
Name: Pwkucii klumipjuiu. Na me.: —
Address:_"(j0 A4A4t4fJ&?, Address:
City: State, PC, City: State:
Zip: �-_JL,4 Phone: =-7V — Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: —Not Applicable
In
Name: Na e:
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 Coun makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conlylict with any applicable Home Owners Association ru ies, bylaws or ang covenants that mayhrestrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions w chmayapply.
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 no sidential use
WARNING TO OWNER: Your fai eto Rpcord a Notice of Commencement may res t* i;51p)aVing twice for
improvements to your propegM No ce of Commencement must be record sted on the jobsite
before the first insucti94). i hd to obtain financing, conisu t le e attorney before
nc
commeAd-n-9 wprlt;,�br rglcvo 17Nctice of Commencement.
ySigribtur2off OwEer/L self/Contractor as Agent for Owner �Slgnature of Contractor/0 rise Holder s
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �� C 0 U N TY 0 F _!�7_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
Z 20/ th is/-:P'Q;� Of
d— by 20/
this _;�?Wof Eby
atez__ 1�?nIe2&)m
(Name of person acknowledging) I (Name of person acknowledging
(Sign aturtB� otary Public- State of-Rorida (Signature -of -Notary Public- State of Florida
Personally Known --- OR Produced Identification
Type of Identification Produced —
Commission No.
ANN m. GAUMOND
Revised 07/15/2014
Personally Known 4� OR Produced Identification
Type of Identification Produced
Commission No.
ANN M. GAUMOND
EXPIRES: December 7,2018
Bonded Thor Notary Public UndarmarRers
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