HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r% Permit Number:
i
ouiming rermit Application
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
I'EKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
pRuPOSEU IMPROVEMEN I LOCAL ION: --_ - ._.
Address: YV/
Legal Description:
Property Tax ID #: J9 oL rC 1�p�lLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED DESCKIN I ION OF WORK: � , g $<'-00`3 G/%tr %Z'f L%ltd Ci/►rst -0 j7r�
/- ?•� T�� /`sem-f ✓ok•✓ cf— Z -S- men, ✓6S«r /�✓t r..i
fo/t r✓ S= Tom �65�-� ✓oke
3 /�Sr�r• /9ItK/
f 1., 7..n /6St�� t�/t.✓ 6
CONSTRUCTION INFORMATION:
Additional worK to e er rmea un er t is -perm-it cFiec a app y:
n Das Q
LIL\JHVAC Gas Tank Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers Q Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 6 `�� 9_0 Utilities: IlSewer a Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name R •Tose-P h d- Pairiek2 R a gcx_ Name: C U VCT I S iSp M kA n S
Address: l05 FndaVC. Cic Company: C(.l3Tom A k(- �2uStems
City: PQ, R -r S -r Lu c i -eState: rL- Address: �' ($ 1/r I� QG e �� r ee a
Zip Code: Fax: City: PO 2T .St . L uct t_, State: Fy-
Phone No. 4(, 8 -9531 Zip Code: a+452.- Fax: 17%?. J 3,5-t q 6Y
E -Mail: fGdytekr �s E ad(ym. Phone No. I'll 335-33_31
Fill in fee simple Title Holder on next page ( if different E -Mail: C u S t c i r Sys P a cdc e'vn.
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA //
STATE OF FLORIDA't U
COUNTY OF
COUNTY OF L C% C` e
The forgoing instrument was acknowledged before me
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The forgoing instrument was acknowledged before me
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(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of 1`1 a j
(Signature of Notary Public- Statof Flori
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
ar�
Commission No_ lT! C7 5,uc b *a , CHRt5TINE6
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mission No. Ul `7 5 5/1 �� ••r"':-`'
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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INITIALS I