HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TQ BE ACCEPTED r .—
Date: Permit Number.
t
L
CEIVED
IP Building Permit Application
Planning and Development5ervices 0 4 2C-18
Building and Code Regulation Division
23CtOVfiginiaAvenue,FortPierreFL34982 �. ou t , Permitting-
Phone:(M)462-1553 Fax(772;4621578 -Commeraal Re
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line t
Y'RIOPOSED(IMP,OV WICATION j =
Address: C, {.�� .�-
Legal Descn i n
Property Tax iD So * neol. d oc 5 Lot No.
Site Plan Name: Ls h, LaLcs (4oat 4,Sr Block No.
:Project Name- 4
Setbacks Front Banc Right Side: Left Side:
:DETAIIED DESCRIPTION 4F WORK::
c K cL 64c 1 q,1t^U
CCIN5TRUCTiOI INORMATtC1N'
rtiona wo to a un r is perr+nrt— a app
HVAC Gas Tank QGas Piping, Shutters owindows/Doors
L]Efetrid Q Plumbing [3Sprinklers. Q Generator Q Roof
Total Sq.Ft of Construction: r 3 _Ft.of First Floor.
"r �
Cost of Construction:$ O "� UtilBies-. Sewer Septic Building He>fig . _ a /j
Nam P1 Name: Ack 44C
Address• • Q .S Company: c K~ .
Crty: i :E -. Address• C
Tap Code:�3 1l 5l Fax: � �15E ' ' State_[._`"'
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Phone No. 7 < � S� Zip Code:J �[a t Fax: ?�- .Cf6 f
E-Mail: Phone No._�
Fill in fee simple Tide Holder on next page(if different E-Mail: �
from the Oiww Med above) State or Countoicenw. -
g value of construcdon is$2W or more,a REOORDED Notim of Is mgdu*d.
DESISNEIVENIMNEM0 Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
aw. state:_."�. CW. state:
Tip: Phone: Zip: Phone.-
FEE
hone:FEE SIMPLE TITLE HOLDER:• ' _ Not Applicable BONDING COMPANY: NNot Applicable
Name: -- _
Address• - Address --
Zr�p: Phone: Zp: Phone: w
I certify ow neto imk or tnsWkson hw oxwnenced ptimlo the o of a permit
1111 11
�>m�a rtEct wtttl�aamrryt res a �Vl m �r+esi ore ch sna,t .
rpAlitumch
ser IMM Please eorrsuttwith.your Name - 110
In cs mAda-Man of the granting afthis mclumted penall;I do her+etarp*2g" hat I WOO In all rem perrom the work
Im am diume with the appnaved plan,the F"Ifla MOW Codes and St Lucie County Amendments.
lbe f batir'Iding paw applications are exemptfrom undetgaing a full concurrency neftw.MOM additions)
amemy strucfums,swimming pools,fences,wails,sW*,soreeAmom wd ammory uses to another non-r+eddentlai use
WARNMR TO OWNER:Your failure to Renard a HoS+rfi of Commencement may result in You�r�a6 t Ake for
im ementsto your prmerty.A Notice of Commencement must be recorded and Oostid on the jobsite
b=the first inspection.If you intend to obtain n&cartsult with lender or an attorney before
Commwork or recording aur Notice of Commeriir�nherrt.
of Owner/Agent/Leuee Slgnahue of ConbactoTHolder-
STATE OF FLORIDA STATE OF FLORIDA+
COUNTY 04 COUNTY O>:
The wasacknowledged me Tby
he - ent admowledgledbeforeno
r _Y
(l+Fdme PNani<e olFperson adkmowledgl+ j
[ of Notary ` State of ) {ire of Notary Public-State of florlda}
Pemndiy Known - V"" OR Produced Ideation Person ally Known �OR Produced hlenbtttcatlon
Type of Identification Produced Tvpe of Idendkeftn Produced
Commisslk n Na. "",,, N I ELS E N Commiss�n Na ,���,�,,, All
rv4,, KAR�NotaryPublic KAR
tate of 7484 ;: ��State N NIELSF -
=_ _. . -s of Florida-
=. ►= Commission#GG.2Qi Notar
oma: i sion ESt ,res Co P
°F �` June 12, 20:4z �'''Pi,i�°`�� - Y Commission �2a84
.._,, JU72, 22fres
Revised a7115/ZO -
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