HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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ouliming rermil Appiica-E
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
NEKMI I APPI- LA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPPED IMPKUVEMENI LUCAIION:
Address:
Legal Description: /
Property Tax ID #: L�gpl -.5p, J ��� �S 7 Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESCKIP I ION OF WOKK:
r
CONSTRUCTION INFORMATION:
Aaiona wo�r C to be perfiorrri3 under
HVAC Gas Tank
11 Electric Plumbing
Total Sq. Ft of Construction:
tYiis permit = cmc a apply:----
[]GasPiping Shutters aWindows/Doors
❑Sprinklers Generator L Roof Roof pitch
Cost of Construction: $
OWNER/LESSEE:
Name A
Sq. Ft. of First Floor: _
Utilities: []Sewer 0 Septic
City: V 1 f, M A n £jL[k State: rZ--
Zip Code: "7 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: curc_Tl `•zSFnititatilc��
company:
C t,(5 -TG Ctt / � t,
Address: t lr°[ 5 �Z;
City: D� (ZT .S t . L v c i e_ State:
Zi p Code: Fax: 7'r? 3
Phone No. 3 3: 13 2
E -Mail: C 4 5 Cc C' 1 c. VM
State or County License: A C o J ( IF 0
if value of construction is $2500 or more, a FtCORDED Notice of Commencement is required.
accessory structures, swimming pu-N, ICJ ILC], W-., --6,,,, - ------
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 rec ding your Notice of Commencement.
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contra r/t_icense Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF ,CU �l e COUNTY OF
me The forgoing instrument was acknowledged before me
The forping instrument was acknowledged before
this day of �i E� 20 17 by this � day of �u 20 17. by
so
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