HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA
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ALL APPLICABLE INFO MUST DF COMPLETED FOR APPLICATION TO BE ACCEPTED
3-9 Date: SCANNED Permit Number: (} - G�
St Lucie County
Building Permit Application kR ` 9 2016
Planning and Development Services Public Vvorks
Building and Code Regulation Division St. Lucie County, FL
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: 's r ?cam/ 96,:)
'Leg alDescri tiorn: CoyVfit�1[eer ��vti Lntb4(rL �ftis Qao` a�r�_
Property Tax ID'#: _2) y 1IL � I (CL 15- lot t Lot No.
Site Plan Name: C�Frr,,f Block No.
Project Name; Lv_G,e.. ,try
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Lic&jowl
Right Side: Left Side:
CONSTRUCTION INFORMATION: III
❑HVAC Li Gas Tank
❑ Electric ❑ Plumbing
Piping UShutters ❑Windows/Doors
nklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$'-0 Utilities:-Sewer❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: .
Name LUiAAm,
C t LA,m
-
Name:
Address:-P_UAJ. � rc c
City:.
Zip Code: i Z __ rax::,2
Phone No.��12-r{a
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State:
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Company: k raj"_ wy<
Address: 1 T fZ V �n D e rx _Rdl
City: �r� State:
ZipCode: Fax:_
Phone No.
E-Mail: �Af"mA__� 6
Fill in fee simple TitfF Hrlc"wr i; v, next'page (if different
from the Owner iss : %�k* ; .
E-Mail:
State or County License: b C_
it value ut construc.Eoo-r• r ; ;.1. i Ott ur mcre.19 RECORDED Notice or Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAN Wff0dWATIbN-',
DESIGIENGINEER: Not.Applicab[a-
MORTGAGE COMPANY: Not Applicable
Name. tA A (t, rNMA
Name:.
Address:
City:.
Address:
City:
—State:
Tip, 3a2trT4717 Ph
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t i -..Phone-:.
FEE SIMPLE TITLE HOLDER:. Applic5W6'*""
BONDING COMPANY: —Not Applicable
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Name:
Name:
Address:
Address:
City:
city.
Zip: Phone:
zip! Phone:
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I certify that no 0work or installation has c6'6menced issuance*of a permit..,.
pn6rto,the
St. Lucie Coun t makes no representation kbat is granting a permit will authorize the permit bolder to bdild.the subject structure,
HoMe Owners Association bylaws or and that may restrict or such
which is in con lict with any applicable rules, covenants prohibit
structure. Pleasd consult with your. Name Qwners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, (do herebyagreethat Iwill, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amencirrients.
The following building permit applications, are exempt from undergoing a full concurrency review: room additions,
. .
accessory structures, swimming pools, fer0s, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:. Your failureitb Record a Nibitib§"of Commencement may result in your paying twice for
improvements to our property. A Notice of Coinmencement must be recorded and posted on the jobsite J:
before the spection. If you ir4end to obt0n financing, consult with lender or an attorney before
comm in ork or recordin your Notice of tornryiencernerit.
Sign�a�e of see/Agent
SigYiatune of Contractor/Lrcense Holder
FLORIDASTATE
OFFL FLORID
!9WOF
COUNTY OF
was a�clmowl
The forgoing instrumentedge' lore me,. - .
7n
The forgoing instrument was acknowledged before me
`this cA_t___ 20
..:
.
this day 20 by
'
Znay _��by
r
(Name of person ack
led in
(Name of person acknova
MICHAI%LMCLAUGHUN
MICH AEL MCLAUGHL
MY WhoISSION #611626-4i2l
I:- MYC0MMISSli0N#FFi626
01 �� ... roe R, 20
(Signature of
-eptemhe,
(Signature of N (-St�WIWIWri a6ridawiarvsonticiixtim:
14M 398-0153
Per•sonally Knciwn -v OR.Producedl ntiflcation,,L�L.
PersonallyAown �OR Produced Identificatio.6
Pq
Type of Identification Produced'
-Type of Identificati(fin Produced
Commission No.'
fl
Commission No. (Seal)
Revised 07/1512014
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