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09/18/2017 02:19 7724663737 BOYLE PAGE 01
ALL APPtUWj FO MUST BE C0kVLETED FOR APPUCATIOM M BE ACCEPTED
Date: Permit Number: I� •O I l 5
RECEIV70 SEP 19'2017
Building Permit Application
Pia a�D�umentserrfce_s •
lttrlldlnp and Code Reaukftn Msbbn
2aW Wrylnw Awam Fort Pierce Ft 3M2
Phone.(772)462-1555 Fact:W2)M2-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dmpbmx click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
t egal Description:
Property Tat iD it: \`�31 d 1— d a ��,.. O d 3 Lot No.
Site Plan Name- Block No.
Project Name:
Setbacks Front,_, _ Bata:�Right Side: Left Side-
DETAILED DESCRIPTION OF WORK:
A.5 40A , 14 sea wro sys nn `7,5 Kw 2a;L
CONSTJtUCTION INFORMATION:
Additl9fial work ad un eris rm --check an a :
HVAC ra.sl ;anks Piping LJ Shutters l,11Agndows/Doors
[J Electric U Plumbing Sprinklers 1:1 Generator ❑hoof
Total Sq.Ft of Construction: Pt.of First Floor:
Cost of Construction:$ � Utilities Sewer U Septic Eullding Height:
OWNER/LESSEE: CONTRACTOR:
Name Name-
Address• +Q.f1 ,
Company:
CRY: �VIU state: Add
Zip Code:
Phone No. p code: q (,,,.,„ Faw 1:1a 44 0- 1
E-mail! Phone
Flit M fee a n%Ae Title Hahler an n xt paW(ft dif[a wtt E-Mail:
from the Qwnar gsafd above) State or Coaniv License- W 1$y&11(
M value of aon uetlaw b$ "L00 ar more,s R�Ctife�Eb Iratice d Com�nena,rrl�nR k m*dr d.
09/18/2017 02:19 7724663737 BOYLE PAGE 02
SUPPLMENTAL CONSTRUCTION LIEN LAW INFORMATION:
0011T OME COWAw. Not#plicawe
Name, Name=
AddfSW Ad&Hs
ate• , Mr. Stag:
Zip: Phone: Zip: Piwna:
FEEVAU TME W "AWkable I10NQIM CONIPAW: Nast ApOkable
Name: Natner.
Addressor Addrew
ft
7p: Phone, Ptwrm
I cenifythat no wont ar ire uNstinn has cmnumnmd prior m#m tssuanae of a p
=Famumftal&
Fian i �ibnrr�s� ar��tat Mt rt nrn �mh
structureYore Ihmm Owners Agrocia' m*W rmiaw v w'deed any MW
In canddairadon afthe arantinp oftfds reque d penift I do hereby agree that I vin In al meds,,,perform the wah
in awxda#+at:with the approved play%the fiorkla 6 and SL We Court 1 mum meots.
s!►e buildr t +►nit ate wmnpt[lane under a Rear mneme eney meeker:nrorrr addldo rw,
am melt sinocb rm W*WmkqpwkfancMwak3kM suvm morns and dory use$i+tt another tforrtwitleedial use
WAS lr0 OWNER:Your fdlum m l I'mttd s Nth of carae*may rterprlt lit Tow Por t ttMim for
imps eats tQ your toperty.A
befo** Nath Of Commenceamt must be rewded and posted on the J*site
Rest Inspe n.If y ou Intend to obtain fina mchA&eamwk Vrith lender or an attomey befiore
ooini>Itencl w�ortt or, vour Notice of cotnmencemeoL
sign"m of own l auft of CamtrmcmrAleense Bolder
t
Gcoli Y of '•.rL 2r COLN rV E OFFDA
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The met►t w �tped 6e!nrstt me1414
71az �SeMbihbg �before
ITof." 17
(Name of pemon ) 4itrrer of persrxr rte)
to a of Hutury OWSlate of Florida) ovature of State of i;todds)
Aers=ft Known�OR Ptraduaad weir O ks"m P+s" n y KnWAM OIt Prod
1�ve of tda►titicatian .
t G AtswiE i aaAvolzl�2020'
notary PtiGtie=8tMi�
Carrrrgisli0n ry publli0p r till
CWaAlltiig0,ills 21,202 my comm.Expires ho at,
tiMllrl
Revised.071
MAIMS FRONT ZONING SUPENVIS R PIANS VEGETATt SEATUfaM MANGROVE
Ctailmm REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INIIIAIS►
09/18/2017 02:19 7724663737BOYLE PAGE 03
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