HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax. (772) 462-1578
PERMIT APPLICATION FOR: A I C.
Address:
Building Permit Application
Commercial Residential 1//
Ly\_
Legal Description:" nck- CAL60 -PIS M — PNS �_ L -AA- I
Property Tax ID #: Lot No.
Site Plan Name: Block No.,�
Project Name:
Setbacks Front Back: Right Side: Left Side:
`.4echanical — Gas Tank _ Gas Piping , Shutters _ Windows/Doors
Electric — Plumbing _ Sprinklers — Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction. $ J Utilities: —Sewer —Septic Building Height:
Name
Name: J nJ%CteA/
Address: Company:
City: i'e1 State: Fl,
Address: Pb,
Zip Code: Fax:— City: �� PJ1/c _ State:�� .
Phone No. t , Zip Code: _ 9 SLI Fa �� b - LJ 2 ( I
E -Mail: Phone No `7__74) 6a 2- 3 J� -7
Fill in fee simple Title Holder on next page ( if different E -Mail r_(n "(�QCJ
n T\i 1dr,
from the Owner listed above) State or County+License679
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
re of Owner/ Lessee/Agent
ature of Contractor/License Holder
STATE OF FLORI �� STATE OF FIL .
COUNTY OF --ULA, COUNTY OF , LLA—
The
A -
The forgoing instru t was acknowledged before me
this _L day of 20_[-_-7 by
, IPA
(Name of person acknowledging j
ti _cam.4��. Uaek
(Si MRI oNfANo�arM I� State of Florida )
lC `;��r►cErllrrrrrr�
Personally Known OR Produced Ider%NA
Type of Identification §* ••.�jM1lSai••.,'°•
Produced
Commission N FF -19 37 F 5w r.
195
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrument was acknowledged before me
this -j—day of 20jj by
IT
(Name of person acknowledging)
(Signature of Notary Public- State of Florida, �%%ktjIrrrrrrd
SABRINA L. E� -CK ``e���� SABRI r, 7,'/
Personally Known OR Produc*'id rrtJ
Type of Identificationp�
produced
.Sommission No? FF 195,33
EiE Ii111���`
PLANS VEGETATION SEA TURTLE 'MANGROVE
REVIEW REVIEW REVIEW REVIEW