HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED V;--
RECEIVED Date: Permit Number: U 07- 0� 7
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Building Permit Applicati n JUL 2 5 2018
Planning and DevelopmentSenr`ices
Building and Code Regulation Division PermI"';
L) rtm e n t
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial R§; C n FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROP OSED.IMPROVEMENT LOCATION
Address:
Legal Description:
Property Tax ID#: � 1.P• 1 1 1 CJ r ' 0 P .O. 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: R1ghtSide:' Left Side:
DETAILED DESCRIPTION:OF WORK =
_
CONSTRUCTfON INFORMATION
A Wona wo to e e orme, un ert is perm=i ec a appy:
HVAC E.Gas Tank ❑Gas Piping v _Shutters F l Windows/Doors
Electric ElPlumbing OSprinklers F]Generator Roof
1
Total Sq.Ft of Construction: .Ft.of First Floor:
Cost of Construction:$ a Utilities Sewer Septic Building Height:
OWNER/LESSEE. CONTRACTOR`:
Name e r Name: C-
Address: d Cv/( Company: !' cI AA
C•Ry; �v Vie„ tate-/- Address• It—
Zip
t
Zip Code:,3 Lt 1.5� Fax: Gty: F !C!C-e, State•
Phone No. 0-3 Zip Code•3 LL 6'>- - Fax: 7 7 a'9F6ry off
E-Mail: Phone No.
Fill in fee p Title Holder on next page(if different E-Mail:
from the Owner listed above) State or Coun 'cense:
ff value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGN GINEER: Not Applicable MORTGAGE COMPANY: _Not Applcable
Name: Name:
A Address:
City. Stater i"W. State:
Tip: Phone: Zip: Phone
FEE SIMPLE TITLE HOLDER:- ' Not Applicable BONDING COMPANY: Not Applicable
Name: -
Address: AM�
City. City:
Zip: Phone: Zr. Phone:
1 seri*that no work or bion has commenced prior to the cerium of a permit
St Lode is rt�akes naomrep��ton that is a vA a the ft ho to build the subject cture
ul
oin �w .your Ham Association rreuiewulmmeOwfiers �rdd�for anV nestrictiorswhich may so*,
In consideration of the grandng of this requested permit I do hereirr aWee that 1 wilt In all respects,peforn the work
in acmrdanOe with the approved plam the Florida BuIldft Coles and SL Lude County Ameridments.
The/owing bubdktg permit aW=Mm aye omrq*from undeoft a full comamency review:room additions,,
acmmysuudwim;,swknmbgpo*,IWm,wWb,s%Msoummmv a9d accessory uses to another non-residential use
WARNING TO OWNER:Your fafture to Record a Notes of Commerhoe 'out may reudt In your-daft tare for
impprovements to your property.A Notice of Commencement must be recorded and{,osbed on the jobsrte
befiore the first inspection.If you intend to obtain flnartdngr consult with lender or an attorney before
ommendna work orrecordingr�'ecordin ur Notice of CommencPnAerrt.
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Sure of Oma/Agent/Lessee Signature of Contr�T ` Holier.
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°' STATE OF FLORIDASTATE OF FLORID r f Z
COUNTY OF $LL -= COUNTY OF o a
csL m vg 3r e
�� The ahstrtr was adatowrtes>gRd before �Q e
The�..�.,��..�fru o
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(Name of person ung) ``' (Name of permm admoav)ec 09)
(Sigthatu a of Public--State of Florida) (5ugumture of State of Florida)
Personally Known) OR Produced Idendficallon Personally Down/ OR Produced Identification
Tape of Identilicallon Produced Type of identillcoo h Produced
Corunission No. (SeA Commisdon No. (Sean
Revised 07115/2014
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTI.E MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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