HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (`1 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 467-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: AQ,
Address: Oji
Legal Description
Building Permit Application
Commercial Residential
W_ -- b KL -'� U Kc
F s--CJs
Property Tax ID Lot No.
Site Plan Name: Block No. 56
Project Name:
Setbacks Front Back: Right Side: Left Side:
IJ TAILE9DE
SCRIPTION OF WORD: ,.
m
}L 7 3rd
- 7TH 40C tq-L t3 3,o
VIolechanical , Gas Tank _ Gas Piping Shutters
Electric _ Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 02b,
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Windows/Doors
Roof
Building Height:
Name I (�,1 s Name: zY
Address: Dkry-\ c1. Company: eff j f A o,,
City: �-� , 4J�(> , State: Address: -().l�D iCJ
Zip Code: - `� - Fax: City: ��_ , N � State:,
Phone No. ' .7 - 79 - i . Zip Code: 3JL 9 Fax:
E -Mail:
Phone No 77�J - 337-7
Fill in fee simple Title Halder on next page ( if different E -Mail i e(s ( Yl L .CC.r7Y�
from the Owner listed above) State or County License 1 5`7
17, 414
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Lessee/Agent
ntractor/License Holder
;=NTV
F IF 'j TE OF FLORID
OFi.ti C r�� COUNTY OF�ta
The forgoing instr Went was acknowledgedefore me The for ging instrument+ was acknowledged before me
-
this day of 24 i by this day of 20 r by
[Name of person acknowledgin ) {Name of person acknowledgin }
1411!11
[Signaturef N t VIA I to of Florida
Personally Known OR Produced Ider#i*d*bti
Type of Identification z
Produced
Commission N� Q ,]�� (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
�LIC�SSA��
1111N1111�1
SUPERVISOR
REVIEW
� � � ! f I111Iflf�ri
S1 ature of Notary Public- State of Florid R:•••�8SIp1�• ���
'* = SABRINA L. Bj-ACK
Re.FiDnally Known OR Produced=31tlei
Tfo of Identification_*
\ �`ducecl °: #FF 195337 y•
a�e� •. Lg &endedl� • Q4ti
Commission Nc#� �rf�5,53 -7 j;� �;,• �`�����
�"'111 111114151 ��i\,
PLANS VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW