HomeMy WebLinkAboutBuilding Permit Application 09/19/2017 00:25 7724663737 BOYLE PAGE 01
ALL APPUCAW INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date: �� Permit Number.
IMMIXIME
Building Permit Application
Planning and DevelopmentServfces `
Aullding and Code Regulatfon Division
33W%lrginle Avenue,Fort Pierce FL 94982
Phone:(772)462--15553 Fax:(772)462-2578- Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the and of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3�q5
Legal Description: MWOW004 (ilkl
Property Tax ID l►: 3 ,!JD 4D& "_000-0 Lot No.
Site plan Name: Block No.
Project Name:
Setbacks Front Back:....---.--------...... Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
bke, 44y Ulu,; ' A&-*I 1 naW Le nnOX :5.5 iWI( S96P, e, w 10 .
C�gW NIo�J 14 ACX-04 ( J Mr Viler MAI # 4AX7 6016;oLtS
CONSTRJXTION INFORMATION:
workLciltlgpml
a orme un er perm -CHEER a appy:
HVAC L..1 Gas Tank Gas Piping _Shutters E,Windows/Doors
Electric �Plumbing Sprinklers Io Generator E]Rwf
Total Sq.Ft of Construction: .Ft.of First Floor:
Cost of Construction:$ 0�V•�U Utilities: Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name WS4__ Name-
Address: q*11 '0OIrffiar1A, �.._-.. Company: t j ti
City:6o-Tit(Ce, State:FL Address: 2
Zip Code: 3µq5 1 Fax: City: State: •
Phone No. �c1.;L(f `��a�_---- - Zip Code: Fax:
E-Mail: Phone No.M. - "& 41
Fill in fee simple'Title Holder on next page(if different E-Mall: bask p, Ce aJL rlgL
from the owner listed above) , state or County License:__LAN 18 1818�0
r
H value of wniouction Is$M=or mom,a RECORDED Notice of Commencement Is required.
09/19/2017 00:25 7724663737 BOYLE PAGE 02
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMA'T'ION:
DESIGN ENGINEER: Not Applicable MOMAGE COMPANY: _Not Applicable
Name. Name:
Address: Address:
City:--_ __--_- State: City: State:
Zip: Phone: Zlp: Phone:
FEE SIMPLE TrU HOLDEN _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address- Address:
City: —
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
st.L is Counttt mala±#no represerrtgttonthat is grarttln a emit will a��e the ertnit hoiden m build the sub d:tr t'uCta►te
Whlrh Ls in d with an applicable Home QMlners Asaciattoh rides, ora caMenantc that may restrict or i such
structure.Please consult m th your Homo Owners Assotatten and review your for any restrictions which may a�ply.
in consideration urthe granting of this requested perml%i do hereby agree dot I will,in all respects,perform the work
In accordance with the approved plans,the Florida Building Codes and SL Lude County Amendments.
The fallowing building permit applications are exempt from undergoing a full con m"ency review:room addtlions,
armory structures.swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your%Nm to Record s Notice of Canmencernent many result in your pgiVbq twice for
Improvements to your property.A Notice of Commencement must be retarded 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 recording ur Notice of Commencement.
signature of Own Lessee signature of contmetorAl en"HoRliw
STATE OF FLORIDA STATE OF FLOR11W
COUNTY OF %• CD1J1 ff OF T.
The foq l igg instrument w �e b me Thedds ►of meY►t we Octane me
oft
—Wby
1■{n\'V/111W'1` . goal�. � .
i.lYl
(Name of person adaowledging) (Name of person ng) .
(Signature of Notaryr
State of Florida) Isignature of Notary tate of Florida)
Personally KnownOR produced Idn*f{rotW_____^ Personally Known a MPraduded IdentiRcatfon
Type of iderdMatlan Produced Type of WentiRtstiotr U
�u CHRISTINE C WEIt
Commission No. ""'"� CNRIBTI�I)ONWEIL Common No. ry Publk of Flarlda
holly POWIC-Blau of Flor Comn+uabn N as 017839
fNy Two.Erpin/Avg ji.3010 Boadrd ihtYuQ11 National Nobly AtM.
Revised 07/iMW wmo�IMIMr Mali d MM.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEAWRTLE MANGROVE
COUWER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
fNl11ALS