HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i Z-4- 1 - Permit Number:
Building r3t Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349£2
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential
PERMIT APPLICATION FOR: To elect from dropbox, click arrow at the end of line
to
Address: R0
Legal Description: VJ V `SI.W Y' S: S/ D ) C dl I
Property Tax ID #: 3 (0 - �J1 Q QQ2.2- - 000 1 Lot No. I F5
Site Plan Name: A._ ' e_! ir_tea Block No.
Project Name:. - )c
Setbacks Front Back: w Right Side: Left Side:
Ret i 'i ` e `r t lue NF i rydo vv's-rd', 1 t' t� '
= 'i77�7n,"7777 777""g
wor b(performed - apply:
Additional to under this permit check a
HVAC I _J Gas Tank ]Gas Piping _ Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers FIGenerator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SgFt.. of First Floor:
I]
Cost of Construction: $) '°1 Utilities: t I Sewer Septic Building Height:
s
a
„
Name t l e4lrU i efl ffi" f Lee
Name: i t t iC C i Ry -n i.,
Address: 37- 9 �yy Eed iY '� r Ed.
Company: — be— 0--1 Q
Address: 06 C -44 V1v4
City '(1 1 M LrfN State: I` L.
City: State: i -#--
Zip Code: Fax:
Phone No. 954- -2_5 7 - ! E84
Zip Code. <a4qq _ Fax:. F 72 -2)%r
E-Mail:�ri? Pt r a,h 0 _
Phone No.
E -Mail: r i n aCa� S Ci ; i1
Fill in fee simple Title Holder on next mage (if different
State or County License: (0
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�-- NotAprflicA-b
Namei—
Address4
MORTGAGE OMPA `ft Not Applioblo
7-ip:
DING COMPANY—NOt Applicable
NamO���
AddrpsS4
Zip:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby roade to obtain 8 pertnit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a Permit;
StALIC16COUnt makes no representation that itgranting .1 )errril
't-oillatithorl7eathis ermithold&io build thesubject ttructyr(4
which is in coh4ict with any applicable Horne Owners AssoclAtic-in A,
rules, byla-, or gnRov6hahts that (nay restrict or prohibit skith
structure. Please consult with Your Fl6r6e Owners AssociotiOn and review your deed for any eestvittlons Which may apply,
in consideration of ih6 gr;,,rit1hg of this ref.,,Uested p6ehift, I do h&Lby agrp-4i,, f1`0 I ?Villi ii, all r =spe tis;
fit --rforb-i the work
in accordance with this 100rOvcd Maris, thO Florida 4011d)0§ Codz,'-',5 dhid LOcki, Cou,"'ItV Ai*,M-nOnts:
The following building permit applicAtIbrit a;te; txonipt firiarn und6l going '. full r�Viow: robrn Addlti,.,),n,
accessory structuress sWirnt'hing P-061tj ft fire,, *6115; q , ;ohs, foiohl§ �,nd jcco§ory lism to another non-residential USP
WARNING TO OWNER: YoOr MiItAtLt to 90cord 6 Notite of MVM V MquIt Ih your pay1hig twice for
imr;rovdments to your property. A Notito -A n-iUst U, r6Wrded �hd poi ted oil the jobsitO
before the first inspectidn. If ydU int0fd1to dhttflh fifir-I.W-irig', il•osult AA,,Ith lender or an attorney bofore
commen-cin-amof-k-or reCofid449-Vour Ndtio otfjf,
6- r
as Agent for Owner
Ider
STATE OF FLORIDA r TATE OF PLORIDA
CO
IC
-OUN a UNVOF C TY OF ---1 '
The forgoing instrument was acknowledged before me
this2_--,�_ day of afy, 20ji by
l
Dame of person statement
Personally Known : OR Produced Identification
Type of identification
Produced.__
(Signature of Notar-
, y)Public- State of I'loricla
11 'M."
Commission No: "'Nty P',',,, (Mb4Y WIDMAN
Notary Public - State of Florida
Commission # FF 929255
Rev
The forgoing inst-u rtas a knowledged before me
-)PY' 20
thig.ZZ day of by
0 0 1 C1,
Vj
statement
Name of Derson s
=n -s rnent
Personially knowh
v OR Produced Identification
Type Of identification
Produced ----.—
(Signature of Notad'y Public- State of Florldd
111-UAN
commissiori No PublicQ Florida
ary Stagof
4, ffs
Commission # FF 929255
Bonded throuah Nationhl Notary Assn.
PLANS V5
REVIM I AEVI VR=VIEW^