HomeMy WebLinkAboutBuilding Permit ApplicationSUPPUMi= 7LCO 4 UEN LAW AT
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FEE SIMPLE M-M € OILDElL- hlot_ Applicable
Name:
BONDWS ccaaPANY.- riot Applicable
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DR A F3 ': AripSmeaa 5s hereby made to ohnein a Ito doihevmrkand msWlabon as andicazed_
Prior to the issuance of a permit.
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Nota�ryNpublic E- State of F ofida
Commission # GG nl7a90
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Ifis -1-p-day of I 2020 by
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Cnmmissian Jtiwr. CHRISTINE J[ LL
unary Public - State of Florida
_._ ,•? Commission # GG 017839
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ALL APPLICABLEI INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a `,1-o Permit Number:
t�
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Building Permit Application
Planning and Development Services
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: ILk3-5 Girls U.l {QAG2 .1%' 34g51
Legal Description: _ ��/1 V115.V_\,_
Property Tax ID #:
Site Plan Name:
Project Name:
Lot No.
Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILEgD DESCRIPTION OF WORK:
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ka�C 04- With �u head
CONSTRUCTION INFORMATION
rti al work to a orme un ert permit—cec a appy:
_ HVAC E]Gas Tank ❑Gas Piping _ Shutters ❑ windows/Doors
0 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S�Ft. of First Floor:
Cost of Construction: $ p Q. �O Utilities: L =f Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
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Name:
Address: ns Deal
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Company: via- r t11rF1 hl� upirifflRq
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City: f'DI(t Pitfct State:-
Zip Code: 3ugel Fax:
Phone No
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Address: 5ra6 Pr _U 1p(k9. Ev�Bd
City: Fbr r efc& State:
Zip Code: '3"5A}�� Fax:-7?�/G-47-3i
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Phone No. - `s'-ZG1ki
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: On rn
State or County License: CA ($ i g I8
vame or core nmmon is >couu or more, a rsccultOtu Notice of commencement is required.