HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( , 044 R.
Date: (O Permit Number.FmEe U
rn a
• AUG 2 3 2016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-11553 Fax: (772)462-1578 Commercial Residential xxxxxxx
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED1IMPRi CIVEMENT°LOCATION
Address: ) 3 ?_4 r e �lW.
i
Legal Description: yy 2S- Gov 'dn 1 d OO V-Y
Property Tax ID#: �� � L Q%/-- [2 D 102 ' 0012 Lot No.
Site Plan Name: / (�-� Block No.
Project Name: Lila Am 0L't, Z ic,.b (�-� -
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'QF.WORK ,
low, e
11
CONSTRUCTION,INF,ORMATION
Additional work to be rprtormed under this permit-check all appy:
HVAC Gas Tank ❑Gas PipingOGenerator
Shutters ❑Windows/Doors
Electric 0 Plumbing OSprinklers Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ ��v Utilities.. ElSeptic Building Height:
OWN ERAESSEE: CONTRACTOR
Name C,!a Name: CHRISTOPHER M SEQUEIRA
Address: " Company: CHRIS PLUMBING &BACKFLOW LLC
City: c C! State:_ Address: 1686 SE 13TH STREET
Zip Code: 3Y 55 d Fax: City: STUART State:FL
Phone No. 9 0 8,9 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.
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�SUPRLEME�J�ITALCONSTRUCTION LIEN LAW INFQRMATION'
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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 thepermit 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.
s
_Signature of Owner/Lessee/Agent Signature of Contra or/License er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 2400..,tEA!ft
Z400.0
The forgoing instrument was acknowledged before me The forgoing instruW nt was acknowledged before me
this_K_day of A v Gy 15--' 20 L-by this r d'ay of 20 !L—by
60
CHRISTOPHER M SEQUEIRA
(Name of person ckno I ) (Name of now a ging
I
(Signature of Notary Public-State of Florida) '(Sig t e of Not c-State of Florida)
Personally Known OR Produced Identification Personally Know OR Produced Identification
Type of Identification Produced 9Z I J lt� 1 { ) Type of Identification Pr uced
Commission No.���P`���� �7i �� WALTERY' (Seal)
=R My COMM #�FF9 MY COMA9ISSION k FF 008997
be[ EXPIRES-.1 w 21 2QJZ
' � ,, ':?;PF �;��- Bonded Thru Notary Public L'ntiaiwriters i
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Revised 07/15/2014 - - �Z7
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