HomeMy WebLinkAboutCAMPAGNA PERMIT APPLICATION 1 '
ALL APPLIC LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
� r
Build'ung Permit Application
Planning an Development Services
Building and ode Regulation Division I
2300 Virgini Avenue, Fort Pierce FL 34982
Phone: (77 462-1553 Fax: (772)462-1578 Commercial Residential
l '
PERMIT A PLICATION FOR: To Selectifrom dropbox, click arrow at the end of line
Address: to S- OCeAA 9 I I R_ F iod-7 `
LegalDescrip on: sr�+nr� ��°`� vi t wv'4 w,
Property Tax #: 35d? `(oD5- 0M3 -yuo- a L No.
Site Plan Na BI ck No.
Project Name C-u y`^Aj r� SI Al-.VN t-4-
Setbacks F nt Back: t.RightSide: Left Side:
eler -�L
� l
ra ;pis, .f , ,,• ,, �, . ,:-�;
u I .`_
-Additional w K to e er orme under t is permit-checka apply:
�HVAC 0GasTank ❑Ga> Piping _Shutters ❑WindowsjD ors
Electric gol_Plumbing ❑Sp nklers ❑Generator Roof
Total Sq. Ft of nstruction::L _ So. Ft,of First Floor: �1
Cost of Constr ction: $ T � • 00 1 Utilities:[]Sewer1�jSeptic Building Heig :
Name T CA mpA rNA Name: C' le.ry ,rk h�wr! ii
Address: b Cott u fi Lk Company: (-a �✓d �}�!2 VI1+i
City: J P Stafe:� Address: 6�1 l��rl rl' �l I
✓ I " 1
Zip Code: 10) Fax: City: tate:
Phone No. 91 - an, — la 32 Zip Code: � 4415 Fax: ID2 16 -163
E-Mail: 5 Phone No. -11D -9ial 10
Fill in fee limp a Title Holder on next page(If di arent E-Mail:vvt d( ur �O✓�
from the Own r listed above) State or County License:
If value of const uctlon is$25a0 or more,a FECO ROEt Notice of commencement Isrequired. 11l
'ia
I
4V
C StGNI? EER NotAPPI MOM SAGE COMPANY: T Not ppii ble A
Name. Name' L
Address: 11 Address: —
Gity, State: _ _ city: State l
tip: Phone.• ZIP. _ Phone:
FEE SIMPLE#TILE HOLDER, Not Applicable BONDING COMPANY: _..,Not Applic le
Name: 99 Name:
Address" 11 Addresn
City, city.
Zip: !! Phone: 21p: Phone:
i
Icarthy that n kor installation has commerw4dpriaeto the lswancsofapermft. 1
Se upa town ekes na rep e t ,tan thatls grer5ting a ermR aut�orlxvthe mk hoiden to bulm die Jett ru are
whichl$Incon ctwithan app�tranp�ttiomea�eroeisAswr�aHwt Ets,byiavugrap�etnrenantspagtmaY orprar.I tWC
siructure.Ple! conwitw7thyourHomzgw++vssAsgoclitoona reulewyouratlaformyrcarractramwhl rrraYauP!y
in consideratla of the grandttgof this cequested permk t do herald agreathat Iwill,in all respects,Perform the work
in accordance the approved piaa} the Florida WIding Codes and St Line tawnty Atntndments,
The followingb lk t green applicistlons are exemp4ot"of
m undergoing,fig efturreruy reyltw:room additions,
accessory strut res,swimming pools.,fersa@s.wafls, ,screen roams and accessary usesto anotiter non-residential use
WARNING T OWNER:,Yau failure fn Aecard commancemerd may result in your paying twke far
imp ovemen to your property.A Notice of Commence tint must be recorded and posted on the Jobs to
be a the h inspection,It you 1ptend to obtvin financf tonwit wlt lender or an attorney before
cam encln din r Notice ofrommen ent.
Signal 4of a Sl ureo ra ae ,,Hold
STA F I RIDA STA O RIDA
cpU a f0U D
The ior Oingl trumen w sa e4md before me The Far r�lrttp e4t uacknowledged before me I
thisa�day 10 b this deyoF Uy 101� 'dsy
- L,11 1 AIJ-1JJ1 r
IName or pars acknow edging 1 iNeme of pa on r ackhoMedging I jl
iSl A*Wre of Lary Publk•State or UN i tslgritture of Ngary public-state of Find a i
ParstsnalYy K ✓/_ OR Produsced ldtntlflCetlan Personally Known � OR Produced tdantlikation
TypaofldentIN tIonProdueed TypvafldatttltlpadanProduoeet
Camrnlrrian �a67lfr`7 isaaii �, CommisponNo:�'f'h7}JSY�,,� 45eat
trpwt;rEari+Toit icreo awy
IWvjS6;d07/ SJ2014 E7tPtREsaHr iu,Z121 +orW BOMk11w9WpY
�harA�6orWE1ira9MJpM Wary sae`m
AN
REUrEW5 FRONT U TER REVIEW SUPERVISOR REVIEW PLANS REVIEW �RDAEWON 5 REVIEW LE A VE
RE IEW
DATE
COMPLETE
IML71ALS
2