HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Y-/'/-/ -7 Permit Number:
• t5miaing vermIT Applicavon
Planning and Development Services /
Building and Code Regulation Division
23oo Virginia Avenue, Fort pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKUVLMLN 1 LOCA.1
Address-----�'IC'�
Legal Description:
✓/c�5 (oZ7�"�!� Lot No._—
Property Tax {D #: Block No.
Site Plan Name:
Project Name:
Back: Right Side: Left Side:
Setbacks Front__
IM_I All t -i) i IION OF WORK:
CONSTRUCTION INFORMATION:
ona wor o e per rme un er t is permit - c ec c a app
UX HVAC H Gas Tank L Gas Piping IU Shutters
11EIectric ElPlumbing ❑Sprinklers Generator
U
Total Sq. Ft of Construction:
Sq. Ft. of First Floor: _
Cost of Construction: $ `� J Utilities, O Sewer 0 Septic
OWNER/LESSEE:
�ZT,1 ' � '
Addres : . ?lern'iKa
City: / 2 �t _J`4''1_ State:
Zip Code:Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Windows/Doors
Roof = Roof pitch
Building Height: i
Name:
Ci'�Ti 'S'A61V11c'qS
Company:
QAddress: 14-.°l5 'SCy' l �G e ��r>?e�1
Pin Rz 2t . L v c i e_ J State:-!
City:
Zip Code:
%1 +q fax:
Phone No.
3 3:5 - 3
E -Mail
C u� T c. S C l� o 1 C G vrt
State or County License: C° C O 5 (-5� l
if value of construction is $25oo or more, a F�ment is required.
CORDED Notice of Commence
^'
S
l/
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of ContracJ/
or/License Holder
STATE OF FLORIDA /
STATE OF FLORIDA
COUNTY OF �f ��C--/-F•
COUNTY OF
The forgoing instrument was acknowledged before nm
The forgoing instrument was acknowledged before me
this lil day of 20 by
this �S� day of _ 20 /Z-by
- Curtis �14anMori s
•a rzrl s
(Name of person acknowledging }
(Name of person acknowledging)
(Signature of Notary Public- State of Fi a j
(Signature of Notary Public- Stat of Fiori
Personally Known OR Produced Identification
Persona lEy Known _✓ OR Produced Identification
Type of Identification Produced
Type of Identification Produced
is
C
�_ `'
Commission No. D 5 T 6 CHRISTINEB
mission No. ►�";
: * MYCOMMISSIONi PG05264 a � �•
ml EXPIRES: April
* * MYCOMMISSIONOG806"
Revised 07/15/2014
�o� EXPIRES:Apr14,2W
I
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
PLANS + VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS