HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Perna Number.
nate:
?!onnirc end Deveiopmen[ 5e.^.11ce5
50ding er.d Code Recuiation Division
2300 '✓irginic Avenue, Fort Pierce FL 3498=
Phone:{772)A52-1553 -rax:(772)^52-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Building Permit Application
Commercia' Residential
- —
Prooerty Tax ID t�: ,fit–_µ<�–.--- Block No.
Site Plan Name.
Project Name.
Setbacks =r,
Back: Right Side: Lett Side.
I (`Sf 1)1ILC (:-)r 2 /4DOr
dltiona wo t0 e pe orne under this oermn – - -
Shutters ,�`.vindcws/Doors
_Mechanical _ Gas Tank _ Gas P,p;ng —
H SprinkierS Generator — RoO
Sq Vit. of .'first =ioor.
To'a! Sq. -t o` Construction: _
Utilities: Sewer _Septic Building Height
Cost of Construction: S 1"lf'Y> —
Name
Nati le
', Company'. 1111-161
Address: _
State Address 1105 o naw
P y
1 \ � � 1 i lr�d<an }�n.Fju-., l�e�cv� �l
L
City: State:
Zia Code: Fax: -
�2
Phone No. � -y Zip Code 393 ax: 32I %i7- qZ3
Phone No. 77Z 337 -41470
E -Mail:— (\J
Fill in fee simple Title Holder on next page { if different
"'t–
Fill
:
Sta.or CourtG
from the Owner listed above
,. License �-'LJI
if value of construction is 2500 or more, a RECORDED Notice of Commencement is recluired.
1 MEMO
M _ _
DESIGNER/ ENGINE _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address
City: State: City: State:
Zip:. Phone: Zip: _ phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name'. _
Address: Address -
City City:
Zip : Phone Zip: Phene.
_a!Mfy that no work or !nsta!laticr has commenced onor to the issuan; e of a Permit.
S _uee Counri makes no representation that i5 s anting a permit will authorize zie pe m hoider w build -he subjec' st ucure
whicr is n conflict with any applicable Nome Owners Association. ulesbylaws or arc osenan s that may esic, or oroh btt <ucr
structure. Please consult with your Nome Owners Associoation and review your deed for any rest, ctions Which may apok,
in consideratior of the granting of this requested permit, i do hereby agree inat ! will, in all resoects, certorrn the work
in accordance with the aooroved pians, the clorda Building Cotes and SL ; � Acle County =.men=mems.
The following building permit applications are exemot from unoergoing a fuli concurrency review: room additions.
accessory 5tnJC7hureS, swimming Poo's, fences. walls; signs, screen rooms and acce=ssory uses to another non-residential c>e
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice fo-
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult wit.`,. larder or an attorney before
COmmenci work or recordi.^. % NoiiCe Cf Comme n Ce m en .
Signature of Owner/ L=_ssee/agent Signature or Contrace 'ucerse noleer
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The - insr ,. as acknov ecgeo�(;r
r pin i
6 ^�e The fo c a Ins-- z_ ac✓.nowladged xrore ^e
this day
of 20 J,]�.E:�- .his day of 20, by
(Nason no ) (Na o Sona .g
( ur - f FericC :ai ._
IIV o educed Id=_atificavon r on �; K P-OduCad iden`nflca OCn
Ty eo, 'de: r o l PC ed
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ix ep pPI NO dY �".Ir. n.:v4 t -nr C'�+IIB LJ. %1i14
Revised 0/, 15/2014
REVIEWS FRONT
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) ZONING SUPERVISOR PLANS
! REVIEW REVIEW - REVIEW
VEGETATION SEA TURTLF
: REVIEW REVIEW
MANGROVE
REVIEW
DATE
COM°LETE
.
INITIAL'
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