HomeMy WebLinkAboutBuilding permittLL APPUIBLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1(I Icil IA Permit Number:
19 Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2340 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
{ PROPOSED IMPROVEMENT LOCATION: III
Address: I bqJ4
Legal Description:
Property Tax ID#: - 002,5-OOO S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
(AILED DESCRIPTION OF WORK:
Wi•{'h l0 KW hQ .
CONSTRUCTION INFORMATION:
rtF 3 Wor to eve( Orme under this permit— check k a apply:
HVAC L i1 Gas Tank ❑Gas Piping _ Shutters Q windows/Doors L
Electric E] Plumbing Sprinklers a Generator E] Roof
Total Sq. Ft of Construction: /- rte
Cost of Construction: $ 3Uc UU . 00
S Ft. of First Floor: _
Utilities:]]Sewer 0Septic
Building Height:
OWNER%LESSEE:
CONTRACTOR:
Name
Address: 10I
S
3ISt_AVQ.,
Name:
Company:Boyk— ns
i
r6 (W� g t
-liddl��'la II YfiL.T C.
r)
City:��jrVl.D((UM Bea,(k State:FiC
Zip Code �J3t)�D�i Fax:
Phone No.
Address: NO Pr E.Q4 LkW .
City: fb(-brRtrC2i
Zip Code: 3 +q 5� I1
`
Phone No.- 9-- L2l-4I4'I
State:
Fax: 77 - �{(olP-37 3i
E -Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E-Mail:,Ja
boo. on En
State or County License:
W,11'81 -31Z
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ERjENGINEER: —Not Applicable
Name:
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: Slate:
Zip: Phone:
FEE SIMPLE TITLE IoLDER: Not Appiicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City.
Zip: Phone:
Zip: Phone:
wwlmcly %-wm a r-Ra"Utc P31-Juvtt: Application is hereby made to obtain a permit to do the work and installation as indicated_
I certify that no work or installation has commenced prior to the issuance of a permiL.
which Is in cori�ictfi a a " lwuHomei "rat sgraming a permit mn authorize the permit holder to build the subject structure
structure- Please consultwithpyourr applicable
ers Assowners ciation and rrevie bylaws or df covenants that may restrict or prohibit such
your deed for any restrictions which may apply.
In consideration of the granting of this requested permit i do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Crates and St. Lube County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review. room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing work or recording ur Notice of Commencement
itev- 8/2/27
Signature of owner/ Lessee/Contractor Agent for caner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF C3i bide,
COUNWOF �. �{(/af,✓
The forgoing instrument ryas acknowledged before me
this j�day of MOVP, O -I' 20A by
The forgoing instrument as acknowledged before me
this day oftkvI y 20J_J_ by
michoe'l F. &I ie
i&a.ei F &_YW_1
Name of person king stAtement
Name of perso along statiment
Personally Known OR Producers Identification
Personally Known OR Produced identification
Type of Identification
Type of identification
P�rooduuccedj
Produced �p
(Signature of blic- State of Florida)
(Signature of Nota blit- State of Florida)
Commission No_ CHRIS F€5l!jCONWELL
Commission {Seal}
Notary Public - Stage of Florida
•"e Commission # GG 0178
ora,, CHRISTINE J. cONWELL
.
Notary Public -State of Florida
REVIEWS
"SOF P:d`••
h Nati
n No ar Ansa
- +'= ommission # GG 0 17839
PIANS
V€ ^L Au #JitRF�'OV€
O LATER
REVIEW
REVIEW
REVIEW
and ational olaryt�rl
DATE
RECEIVED
DATE
COMPLETED
itev- 8/2/27