HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFq MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 i Permit Number:
1E InM
Building Permit 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
PERMIT APPLICATION FOR: TO Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:-.... c! V
Legal Description: IvE r7Z_ .6 s e- A � 1 /�� . %� �' ' �� 5 �e�1 1V s � C -L 58
ivo l & i 7-A S' 14A14AR6 i tv Qm Y o ii M l LIQ a D— 2-7 3
Property Tax ID #: S_b 2 `5 ' L? _77S' ` 6 0 (3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe performedunder this permit -check a apply;
OHVAC F_JGas Piping Shutters Windows/Doors
Gas Tank _
EElectric F1 Plumbing O Sprinklers Generator L_J Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
[]Septic
� Building Height:
Cost of Construction: $ _1 7 9 Utilities: Sewer
OWNER/LESSEE: CONTRACTOR:
Name:. i I'•P ,`� i� l __ _
Name
Address: '!�- Wu_-aj Va.. Company: A I FREI) SA W
City: State: -L Address: a'kl G d W
Zip Code: `-tl q Fax: City:':5 C AJ 3 &A C4 Stater
Phone No. Zip Code: =_ Fax: D --33q—'9 -776
E -Mail: Phone Na. 77 3'-f'" X10 I q -
'
Fill in fee simple Title Holder on next page ( if different E -Mail: 6�{ 5 ' QC T C +! o '
from the Owner listed above) ,State or County License: E C _0640 0
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
€ SUPPLIEME TAL CONSTRUCnON LIEN LAW NFORMATION:
DESIGNER NEER; _ _- Not Applicable MORTGAGE COMPANY: � Not Applicable
Name:
Lily. State
Zip: Phone- Zip; Phone:
FEE S HOUNUt Not Applicable�f: € DIING COMP of Applicable
Name:E�atne; _�__._
I vertify that no work or jnsWafion lis txsrrtme prior to the issttant a of a alt.
'•. - � � ...�. ..,+�. :agasaEa:.s ua 333zu t zki>&�ktkkR=��?�s�E �d2��' �$���£� �'�TCis?�,° . .2 #t?i ln motion of the granting ofthis requested pernk I der hereby agree that I wilt, in all respecis, Perform the work
in accordance with the aped pbm, the Florida Building Codes and St_ Lucie County Amendments_
The fa ng €sWWtng Pern-dt app4cations, are exempt from untying a #till concurmxy
re env: room additions,
accessary stnxtures, swrmnnng pouts, fences, vlalls� Wit% screen room and awry uses to anodwr non-resedenbal use.
Y
Ware the irlsp,�
- if VW Menai to chain -finmdny, consult with tender or an anorney before
cornmencim work or Te di yourice of Conunencernent
41
STATE OF FLOM STATE OF FLORIDA
COi#ilf V Of COEiM* OF
Ttte Ment was admawtedgel bef we fm The fowing instrtment was aged before me
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tf� of parson -`rig ng I ......_ - . - (Natne ct person admor�ledit )
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personaY tics fly Known � R Produ fde t€frcat on
Type 100f�ua n Public state - Type of Idersti�t
Dianna
< MY Commission GG 088988 � 0 Notary Public State d Fko a
Ct mffftSsiGn lilt3. ares o512112t7 a1 Casrrtrrtissitsn Islas. Dianna I(nignt
45Fa�'rnmission
c Expires 06121/2021
AW2614
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