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HomeMy WebLinkAboutMasters - 6805 Santa Rosa Pkwy FP SLCAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 19 11 -�-' ( 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� Address: U ?5 C) Legal Description: %e Building Permit Application Commercial Residential M bE:,6 /-7 -:� .27-0 Property Tax ID #: 5D 3 - �; 3k V [] Q - Lot No. �� Site Plan Name: Block No. /5 J Project Name: Setbacks Front Back: Right Side: Left Side: L5 U—'� i 'V rM- 1 LQ fD .lam t I[LLL3 " aitionaI work to be performe uner t is permit - c ee a t a .. .,.M tappY: !-, echanicaI _ Gas Tank _ Gas Piping Shutters Electric ` Plumbing — Sprinklers Generator Total Sq. Ft of Construction: Cost of Construction: e Sq. Ft. of First Floor: Windows/Doors Roof Utilities: _ Sewer _ Septic Building Height: Name I f s.l % QA(3s-�te_v Name: J CLVY1 i. ' .... Address:Q 5 ^�,p� �, Company: t5 ✓p City: -, P..v, C -E- Stater Address: Zip Code: r Fax: Cit eAe— Y� _��► � Stater, Phone No. a - Y4U- c -a- Zip Code: Fax: E -Mail: Phone No_ ! - 6,; - .3 -2:, _J Fill in fee simple Title Holder on next page ( if different E -Mail from the Owner listed above) State or County License % If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. ture of Owner/ Lessee/Agent re of Contractor/License Holder STATE OF FLORID STATE OF FLORIDNV COUNTY OF -�---i ("- COUNTY OF 4—t c1 The forgoing instrument was acknowledged before me this day of 20M by (Name of person acknowledging') (Signature of Notary Public- State of Florido0lilifflrlp,� SABRINA f ACK ,,``SpP�.......`. ''ii Personally Known OR Produc Ide�, Jaakw�z� Type of Identification �� o�?L!y2 ao•. Produced 4±4 °�,•� y�* Commission No.F^ �� �``f a,TI85337 a The forgoing instLwi.c-Aent was acknowledged before me this � day of J L-�.- . 20 -1 by Ji (Name of person acknowledgi g) (Signature of Notary Public- State of SABRINA L. BK Personally Known OR Produi Type of Identification Produced Commission No. Fi- i "4S -�.37 XN- REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ?: .pMIdIISS1p'a;x'G� Y rptuary2'�'��.� Afifcationi -, rn PICco 19533 �F JA" MITE 01 �,©\P" MANGROVE REVIEW