HomeMy WebLinkAboutBuilding Permit ApplicationALLAP INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - 2-0 Permit Number:
Building Permit Application
Planning and Development5ervices
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 v/
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: '/
address: 12(09 Sn ,il r 'G _ (tri• SLln 45
Legal Description:
Property Tax ID #: 7!50 3 - 2t l
Site Pian Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
U L : JnSWt he.w iPu,u.D 3 �n� r 4 S G�ek�
Wii'h 1D U hee.
CONSTRUCTION INFORMATION:
Aaditipmal work to (e orm under ispermit-checka apply:
HVAC L _I Gas Tank E,as Piping _ Shutters (ate Windows/Doors
Electric 0 Plumbing Sprinklers Generator Q Roof
Total Sq_ Ft of Construction: So Ft. of First Floor.
Cost of Construction: $ � � X0.00 Utilities: l _ISewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name .
Address:_ S i
Name:
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Company:31)VIQ_ N(
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City-?Af 6_ m L C State: R,
Zip Code: 3i OAR Fax:
Phone No.
Addresss:5(d 6J A .PYI'E%f(
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city: t'tJf-j--,- Refs ,,
Tip Code: S 4q sI`
PhoneNo.-"A- 110(-�-1,14-1
state: rt,
Fax: -71X- 4& -373'7
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail:
,`{ a (n
State or county Licen e:
CAC 181 '31$
it value of construction is $2300 or more, a RECORDED Notice of Commencement is required.
'SUPPLEMENTAL CONMUCMN LIEN LAW INFORMADON-
Slgirature Of 0i9'IleC/f_e55ee%t.nmtC3CtOC Agent fUT WneE
BE
ji MORTGAGE COMPANY. Not Applicable
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City- State.
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Zip: Phone
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Name:Address.
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CON
OWNW = Application -s hereby madeto obtain a Permitter do Ilse work arsi instatlatioo as indicated.
I certify thatno work or installation has con menced prior to the issuance of a Permit
St:.ucieCo-�anaakesnorepresentation thatisgrantimgapermi,,will acrthorizethep� itholdertobuldthesubjectstructure
which ism with awfaippiicable dome Owners Association rum, bylaws orand covenants that may restrict or prohibit such
structure- Please consulter your Home Owners Association and review your deed for amy restiici"sans which may apply
in consideration of the granting of this requested permit 1 do hereby agree that! will, in all respects, perform the work
in accordance with the approved plams, the Rodda Eltulding Codes and St tude Cou arty Amendments.
71ne foilawimg building permit applications are exempt from undergoing a full mruxure:xy review: rrom additions
accessory structures swimming pool%fencers, walls, signs, screw rooms and accessory uses to another non-residential use
WARNING TO OWNEP--Y failure tae- Record a Notice of may resuftin Vow ' 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 frraancin& const t with lender or an attorney before
comencin work or record your Notice of commencement
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