HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater Permit Number:
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Building Permit Application AUG 2,0 201$
Planning and Development Services
Permitting De t m e n
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 L S t• L C�u n �/ FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Rest e
PERMIT APPLICATION FOR: �'�it IeS
- To Select from dropbox, click arrow at the end of line _
OPOSED IMPROVEMENT.LOCATION
PR
Address•
Legal Description: 4 S haiorw
o X30 f 3
Property x ID#: �� •v O�d + Lot No.1
Site Plan Name: JAkiffikLk ` J Block No.
:Project Name:
Setbacks Front Back Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK:
n�c
CONSTRUCTION INFORfvIATI
ON
Additional wor toe e orme under tispermit-checka appy:
OHVAC [3 Gas Tank []Gas Piping Q OGenerator
Shutters Windows/Doors
Electric Plumbing E]Sprinkiers Roof
Total Sq.Ft of Construction: S .Ft.of First Floor.
Q�
Cost of Construction:$ Utilities: —Sewer D Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name Lq r + r d l'I.S Name: c¢ CIC
Address: O r SOK Company: j r m�
City: "40- State: Address:
Zip Code:.3!( Fax: City: Ffi f State:
Phone No. 7 7��3wwwd///} '•'3� G Y Zip Code:J tf t� • Fax. 7 7 Lf�wv
E-Mail: / - Phone No.
Fill in fee simple Title Holder an next page(if different E-Mail: ce �cGr �eD
from the Owner listed above) State or Coun License:
0 value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNS ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Trp: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:• ' Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: ' "" Address:
City: City _
Tip: Phone: Zip: Phone•
1 certify that no work or irstallatlon has commenced prior to the Issuance of a permit
St lode County makes no representation that grarrting aermit wfD a the oerr a holder to bund the subject structure
whkfi is in onruflld with ar�Yapp cable Home Owners on rules,�or an eovwhartts that may restrict or prohibit such
structure.Pl�se mnwlt with yaw Home Owners Association and review your deed for arty restrictions which may apply.
In consideration of the granting of this requested permit I do hereby agree that I will,In all respects,perforin the work
In accordance with the appy per.the Flodda Bullding Codes and St I.ude County Amendments.
The fmikwrUtg'biDdI ft permit applications are exempt from undergoing a full concurrency rehdew:room additions,
accessory structures,swimming pools,fences,waft,sot%screearoonnand accessory uses to another now4addentlai use
WARNING TO OWNER:Your failure to Record a Notice of Comnwmv errt may result in vow-Wong twice fior
isoprovements to your property.A Notice of Commencement must be recorded and{costed on the jobsite
before the first inspection.9 you intend to obtain finartcin&consult with lender or an attorney before
commencing work or recording our Notice of CommenceM
Signature of Owner/Agent/ � ';; of Cour Holder s
STATE OF FLORID p a m:;5 STATG OF FLORIDt*
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COUNTY
OF V�o t3l COUNTY OF m<
y � T O
The — The ��
was x was before �T
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ffik of is of ZEo
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(thmeOfpersw (Name of personacuhowled")
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JAUM
(Signature Of iic--State of Honda) (Sigrwthure of No -State of Florida) . V 61
Personally Known OR Produced Identification PersonaRV Known OR Produced Iden
'type of ldendflgtion Produced Type of Identification produced
Commission No. (Susi Commission Na (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
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