HomeMy WebLinkAboutBuilding Permit Application ALL APPLICLE II FOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED/
Date: C� I Permit Number:7M.1
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Building Permit Application
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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 xxxxxxx
PERMIT APPLICATION FOR: . �M
PROPOSED•IMPROVEMENT LOCATION
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Address: 15739 Iy k) Oh S CIA-
Legal Description: q q24^ $/S-" o 0�- j)o d-
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA!LED-DESCRIPTION O.F WORK
lkn Com- Vq.f.V e W I Ui
CO:NSTRU.CTION-�INFORMATION.
ACIClitional work to be nerformed under this permit-check al app y:
HVAC Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
0Electric 0 Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Utilities:ll Sewer D Septic Building Height:
OWNER/LESSE:E .CONTRACTOR::
Name 6e fyto agq PiA Name: CHRISTOPHER M SEQUEIRA
Address: �s3g N CA--* N��cJ nW.T Company: CHRIS PLUMBING&BACKFLOW LLC
City: vK C'( i? State: r(- Address: 1686 SE 13TH STREET
Zip Code: 3 e d Fax: City: STUART State:FL
Phone No. •f' Zip Code: 34996 Fax:
E-Mail: Phone No. 772-341-7473
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CFC 045990
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S+� Pl1A PLEMETNTAL CONSSTRUCTION LIENLAW INFORMATION:
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Con cense Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF L C I COUNTY OF �
The forgoing instrumpnt was acknowledged before me The for,g,oyi,ng instru ent was acknowledged before me
this�day of is>1 d 20 by thisL3 _gay of 20 14_by
CHRIST EIRA
(Name of person ac now edging) ( e of person ac wledging)
(Signature of Notary Public-State of Florida) C� (Sign r ry Public-State of Florida)
Personally Known OR Produced Identification Personally KnoOR Produced Identification
Type of Identification Produced pe.ofdd ratification duced
X; WALTER OOMMZ I
Commission No�l✓���+ E"� 171'�l� e °: MY commiS8t rCeffRlimiOn ;•,1 `.P�o-. aS H.MUSA ea
EXPIRES tuber 17,2019 _� *"__ MY COMMISSION H FF 008997
a= EXPIRES:Juiy 24,2017
(4t17)399st�3 fIOrIAE(dar enrire com .•'i:•'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS