HomeMy WebLinkAboutCCF10122017_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /o 1 Permit Number:
s J q.
• tsuiiomg vermis Appncavon
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
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVtM1=N I L_OC_AI ION: _ ....____-
Address: - ------1 $7 5 `�,�c212kyl— ("tA LU
Legal Description:
Property Tax ID #: a� D 3 J 1l - CN5 ` CON 5 Lot No..
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
z /,/ S,-,r�"`,�nS L o /o/Z t,/
CONSTRUCTION INFORMATION:
AddAiona wor c to a per ormed un er t is permit =
HVAC L� Gas Tank uGas Piping
11 Electric U Plumbing 11 Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
trial appiy:
Shutters []Windows/Doors
11 Generator F]Roof Roof pitch
Sq. Ft. of First Floor: —
Utilities: 0 Sewer a Septic
NarneTo�,2nh�wz Nall, Mci�ul�nn�
Address:
City: Fofd Ptn_nc-r� State: FL
Zip Code: q ggS1 Fax:
Phone No. Tja 742 &,-1 91
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
C L' r, T I r fSN rL14ti1C; I
Company:
C'u -s—r6 rVt A
r L-0 t e�jl;
Address:
14-15 C �/t I (
d Q L1 r ee r1
City: Cc 2T St , L v c i c-
State: r�—
Zip Code:
4+g5,1_
Fax: 77.)- ci �
Phone No.
1 a- -33:5-
2 a
E -Mail:
Cu titf�t!
Sy, £ QC'� CGVYI
State or County License:
If value of construction is $25oo or more, a RECORDED Notice of Commencement is required.
before the first inspection. If you intend to obtain tinancing, consult wltn Ienaer or an dLLU111cy UV1U1 1U
commencing work or rec ding your Notice of Commencement.
,
S
r
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA�t /
t
STATE OF FLORIDA
COUNTY OF
COUNTY OF �J �t, U C l e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this loL day of OCT 20 1? by
this I d day of CC T 20 17 by
- Curtis �14MMot? S'
.trzTI S J nAl Mo n S
(Name of person acknowledging)
(Name of person acknowledging
Si Stat of F{o
(Signature of Notary Public- ri
(Signature of Notary Public- State of F! a)
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification Produced
U1 U1 0 5 7 b r""°�,� CHRISTINE B
Commission No. �t
/Produced Mi
, I
mission No. ••• ►�~ :; `'
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MYGOA+IMISSION/
a EXPIRES: Apa
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Re-vised 07/15/2014
�o� WIM:Apd4,202t
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW 1
PLANS VEGETATION SEA TURTLE MANGROVE
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