HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO B Permit NED ber.
Date: � ' � � �
L)unuing rermL Hpplicavon
Pkrnr:ing and Development Ser�rices
Building and Code .Regulation Division
2300 V,,rglrua Avenue, Fort Pierce F' 34982 Residential
Phone: (772) 462-2553 Fax- (772) 462-=578 Commercial
NtKNlll APPLIC;AIIUN t-UR:
To Select frorn dropbox, click arrow at the end of line
1'KU1'USEU IM}'KUV1=MtN 1 LUCAl1UN: -
Address:
Legal Description:
Lot No.__
Properh, Tax ID #: J4a %-%v Block No.
Site Plan Name:
Project Name: Left Side:
Setbacks Front.
Back: —Right Side: _
Izit'IION OF WORK:
CONSTRUCTION INFORMATION: _ - - -
Adt3Ftiona vror to a Qe— rformed-- under this perm Et - cFeck zTi ►�-app-TY- -
1zHVAC Gas Tank ❑Gas Piping
Shutters aW!ndows/Doors
Electric a Plumbing oSprinklers
1 Generator Ll Roof Roof pitch
Totai Sq. Ft of Construction: /
Cost of Construction: $ 4 �
OWNER/LESSEE:
Sq. Ft. of First Floor:
Utilities: 0 Sewer Septic Building Height:
CONTRACTOR: _
Name Toh� +ck to
Address: �
City: �0 27 �-t vC State: F`
Zip Code: Fax:
Phone No. 70 ' 3 9 84
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Gi'IcZ(s ,SA6t OtC(I
Company:
C U 57b rtit A, C J S t ru
Address: �i l 5 1.�1 I (dCr c' �' r ee, rk
PC P--r .5 t • L uci c- State: �C-
Fam City: ry
Zip Code:
Phone No. 71 13 3 S- 3 2 3 -L
E-Mail: C a 't 0.C,�
State or County License:.
If value of construction is $7500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN I ALCONS ONS I RUC IION LIEN LAW INFURiVIA I ION: .
Name:
Address:
City:
Zip: —Ph one -
FEE SIMPLE TITLE HOLDER:
Name-.
Address:
City:
Zip: Phone: _
Not Applicable
State:
Not Applicable
MORTGAGE COMPA
Name:
Address:
City:
Phone:
Zip: __--
BONDING COMPANY:
Name:
Andress:
City:
Zip: Phone:
— Not Applicable
State:
Not Applicable
rmit-
1 certify that no ,pork or installation has commencedn{ oratoQm�-- tle U II authorize ance of aet e permit holder to build the subject structure
St_ uicie Countv_makzs no rot resentation tt sat is �rrestrictions which may apply-
St- is in conflict witn any aPPI'�ble Om,•,ners Association tiand rev e�� your deed for any ants that may restrict or prch: tt sucn
structure_ Please consult with your Ho in 211 perform the :ark
In consideration at the aramoveOf t d plans, the Florida Building Cedes ahis requested perrnitI do nd St agree
lde Couat nty Amendments.
in accordance with t PP review: room additions,
+a'ls, si ns, screen rooms and accesson, uses to another non-residential use
The follo.P;ing building pern�d applications are exetrptfrem undergoinga full concuren
accessorn; st octanes, stiti�mming pool, fences, -- commencement n yourtwice far
WARNING TO OWNER: yourfailurr'etoRCe of Commenc menrd a Notice of must e rec�i de or an attom d posted ongbefo�esite
co
improvements to your property- - consult with le
before the first inspection. If you intend to obtain financing,
commencing work or recording your Notice of Commencement.
1 S
Signature of o�.;nerj�essee;Contractor as Agentfor O.vnzr
STATE OF FLORIDA
COUNTY
The forgoing instrument :-fas ackno�:ledged before me 20� b•
this ; / day of
i
(Name of person ackno..tedging j
�� .5 sir _ --. = _r . •
(Signature or Notary Public- State of F:crfda )
Personally Kno`sm OR Produced Identification
Type of identification Produced
commission No-
Rex-ised G/- i 1-512G14
r _(yam CHRISZtNEB
S A{Y COMMISSION
REL'IE\MS EORONTENT ING
R REIN
4U W
DATE
CC:MPLE t E
INITIALS
signature of Contracorlucense Holder
STATE OF FLORIDA r:
COUNTY OF__- —=
The forgoing instrument w2s acknowledged before me
this day of 20 by
(Name of Person acknov, ledging )
(Signature m Notary Public- State of =lerir
Personally Knawn OR Produced Identification
Type of identification Produced
C1' ' rjK
�Y PUy RIFT'=:•� , �
VZ4I
w5Ihmission No_ ' ` R 32,
aa�oeaTM� B+�a't N�YS<rv�rs
SUPERVISOR PLANS
REVIEW REVIEW
MY COLIMISSiON # GG 6bZaC3
w1 EXPIRES: Apr? 3, 2021
VEGcTA T 1ON ` SEA TURTLE MANGROVE
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