HomeMy WebLinkAboutHerbertpermitPlanning and Development Services
Building and Code Regulation Division
BTa Virginia Avenue, Fort Pierce FL i4982
pfron"' iltz) qaz-fi53 Fax: {7721462-1578
ALLAPPucApLEII{FoJVIUSTBECoMPLETEDFoRAPPIICATIoNToBEACGEPTED;;, IDIfD llB
Building Permit APPlication
Commercial
Address:
Legal Descri
Property Tax lD #:
j\
Site Plan Name:
/\./
Residential A.t.
L{Y
1
Lot No.
Block No. \ tZ
Project Name:
Setbacks Front- Back:
-
Right Side:
R
permrt -
Left Side:
Shutters
Generator
\,Ke
l-1o., Piping
tr [lsprint<ters tr tru Windows/Doors
Total Sq. Ft of Construction: '-'_-
Costof Construction:ffi
It vaiue of construction is 52500 or more, a RECORDED Notice of Commencement is required.
.D TDsf,
'AD Nctrr
Ehuo.
[-lr'".,,.,.
Gas Tank
Plumbing
PERMIT APPLICATION FoR: To Select from dropbox' click arrow at the end of line
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Company:l
ndargps:{0
A e state:*l11L?nzffr
State or County Lictnse:
State:f'l
Phone No:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
lZlp:,,,-,,-.l,:nrlinctalhtionasindicated.
owNER/ coNTRACToR AFFTDVTT: nppri.riln-i, nffimade to "G;" oo"'ri. ro do the work and installation as it
I certify that no work orinstallation has .o*r"ni"-i'piio, to tt't" issuance of a permit'
L^-i-^ +k6 ^armit holder to build the Fubject !T!lcl9l.e^'
il#LftHy*t3{,:lffi,,:{ffirffiilrif,r,'asnffimi*tin',n'iryiirk#i{':-itlf*i:*'}:isijlffr1'''h
fi ::H;x:.",.,:T;ll[::','J,1$:,"1i]*::ru;',$fl:";,njilJ:j]"J::ffi3i:iJ]]J#ldt?llffi*""k:"'rorm
the work
The following building permit applicatio-ns are exempt from undergoing-a-full concurrency review: room additions'
a.cessory Str,ctures, swimming pools, fences, *tll', 'ign" screen rooms and accessory uses to another non-reSidential USe
WARNING ro owNER: Your rairureS.o 5eco1!31P11"^"-l*lgf::lTIl*:YJ:'J:tJ! I"":[3i'ilt H'jTJ3'I"WARNtNGToowNER:YourfailuretoRecordaNotlceoTL[,]I|IlIEllUElllE..l,..-'.--_.;apostedbnlhejobsite
. imorovements to your property. A Noticl"of C.;*r;-.."ment must be recorded a:
betore the first inspecrion. rf you intena L"i6't.i" iinancing, i",l!r'it *ii[ltnotr or an attorney before
;;;;; ;i ; j wo i[t-ii"ioiJ i'ie vou t hl otite ot co' m
"1
t" m "nt'
Signature of
STATE OF
Name of PerFon making statement
Personally Known -\- On Produced ldentification
Type of ldentification
(Signature of Notary Public- Stat
Commission N
Expires: Ogf 28, e()ffi
1ST TLORIDA
H; itr[il :;*ffiffI5€H"-l"#jHefore
me
'/ Lessee/Contractor as Agent for Owner
Name of pgrson making statement
Persona lly KnownL- OR Produced ldentification
Type of ldentification
re of Notary Public-
rComEision#FTL72372
iffitHs:OCr292018
SEA TURTLE
REVIEW
DATE
COMPLETED
Rev.8/2117