HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: v 3 Permit Number.
RECEI t-
Building Permit Applicatic in JUL 2 3 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce Ft 34982 '
Phone:(772)462-1553 Fax:(772)462-1578 Commercial 119id f CO •tY, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address: 5�/, C e. e
Legal Description: A)6 3 qt 43 I 1 _?&/4 c� Syckwn (? t 36FG AF
O Gr of
Property ax ID#• 6 Q d '
Lot No.
Site Plan Name: i Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
. DETAILED DESCRIPTION_OF WORK.
CONSTRUCTION INFORMATION =
rtiona wor to e e orme under this permit—check a app y:
— AC. �Gas Tank Gas Piping _Shutters (]Windows Doors
Electric 0 Plumbing I Sprinkiers a Generator F�Roof
(Total Sq.Ft of Construction: 1 3 O ' SCD .Ft.of First Floor:
Cost of Construction:$ d ac) Utilities.
Sewer Septic Building Height: l
,OWNER/LESSEE CONTRACTOR:
Name l2 dJ Name: #16
iAddress: 01261 � Company: K c a �!�
City: State:, i Address: L 3 E [cam
Zip Code:. c5� Fax: ✓v City: F f iCVC-e' ff State:
Phone No. G S < Zip Code: -3��(�� Fax: 2 7�- V446 Mf7
E Mail: Phone No.
Fill in fee simpl Title Holder on next page(if different E-Mail: C re v' (2 ec;ft If Qfl1-
from the Owner listed above) State or Coun icense:
9 value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
F
ISIGN ENGINEER: Not Appiica le MORTGAGE COMPANY: Not Applicable
me: Name:
Adores, Address:
W. State: CRT. State:
Zip- Phone: Zip: Phone:
FEES SIMPLE I I HOLDER:• ' _ Not Applicable BONDING COMPANY: Not Appili able
Name• Name- _
Address: Address:
City " ' �Y• - - .
Zip Phone: Zip: Phone:
I aertNy that no work or installation has commenced prior to the Issuance of a permit
St Lode Court makes no repr N ion that is 81 a ft w�l >ioriae the�e it holder to bind the subj;a strucdme
whkfi is h1 co d wdh amI app Home Owners l�on ndes, or an .00vendmts that may restrict or prohibit such
structure.Please consult wnhyour Home Owners A�odation and review your deed for airy moons which any apply.
In c�ntlderation of the granting of this requested penny'!;I do hereby ag ee that I will,in all r perform the work
in accordance with the approved playys,the Florida Building Codes and St Lude County Amendments.
I '
The followirlgt+»�dirlg permR applications are exempt from undergoing a fiiil oonaymenq►review:room additions,
accessory struu#yyre�swimming pools,fences,wa1L�sue,suxe�room�.anci accessory uses fio another non-residential use
WARNING 710 OWNER:Your failure 1D R�ord a Notice of Commencement may resuk in yotir�oaying twice for
improvementsto your pr>t}perty.A Notice of Commencement must be recorded and{iosbed on the jobsite
before the first inspection.if you Intend to obtain finandng,consult with lender or an attorney before
cmnnmfclng Ing r Nofte of Commenoerlhe
Signature of Owner/Agent/Lessee Signature of Contractor Holder-
STATE OF FLORIDA STATE OF FLORIDA '
o JUMOF CDUNTYOF
e
The The instr was adayowledged before me
this2 was day of 20 ayof 2 _Wby .
-44
�4- 0�n �' �Ll ekyq�
(Mayne of person admow;Wng) (Name of person0,14 hl.
acknow )
Y -
(Signature of Public-State of Florida)v U (5rg 0WM of Notary State of Florida)
Pe'sonaw Known /OR Produced Identification tonally OR Produced Ikon
Type of Identillcation Produced f, Type of ldend cation Produced
pliREY
COI ISStOn N Y P AUDRM S00817mn EY B.HUMI .
•' MY S:M 6,2023 MY COMMISSION_* EXPIRE 0 #GG 300817
•��FOFOP`. N '`Fop F'�PS
Bonded Thru NDtary Public Underwriters ,
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