HomeMy WebLinkAboutBuilding permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
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Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of tine
PROPOSED IMPROVEMENT LOCATION:
Address:r
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Legal Description: SpWr�
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Property Tax lD#: X306 -'5500 -OI ( -000-,Lot
No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
r to a orme un er t is permit- check
HVAC Gas Tank ❑Gas Piping
Electric F-1Plumbing❑Sprinklers
all that appy:
_Shutters aWindows/Doors
0Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ . UO Utilities: Septic Building Height:
OWNERAESSEE
CONTRACTOR:
JJ
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Address: �.i U0 S
Name.
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Company: Bnylg,. Til( (WAl d� KU ►1G
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City: rU(( �(L f �Q� State: �
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Address:5(d R' T�( /t
Zip Code: Fax:
Phone No. ��� ilb� .-1;.0i
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City: YUf b- Refcp State: F -C.
Zip Code: '3 0 5� }J Fax:
E-Mail:
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Phone No. -T13,- `ts2(-414-1
Fill in fee simple Title Holder on next page ( if different
E -Mail: , 11 A (Y}
State or County Licen e: 1C, 1$ IS f 3
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SU3Pds iE t€LC4.—ANST AUCTION UEN LAS INFORSidiAT10 :
DESIGNWENGM£ .
Name-
— Applicable
E ANY- MotApplicable
Name:
Address:
Address:
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Zip:—Phone—
State:
City: State-
tate:Zip:Phone Zip: Phone:
FEE SIMPLE TITLE ER;
Name:
flot Applicable
Somme aMPANYdratAppriabie
Name:
Address:
Address;
Cdy:City:
Zip: Phone:
Zip P#me-
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consideration the granting_ herebyagree that - -iLperformtfie mmirk
20conlance with the appraved plans, the Florida Building GDdm and St- If 1 CountyAmendments
e following building permit applilcations are exempt from undergoft 2 M cmaerremy review- room dYx
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STATE OF FLORIDA ii a r /,,,� ATE F FLORIDAI f�
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,�ipY p`e•h- Nti �nni811NE J. CONWELL
Commissian g i .`otary Public - S{ Florida
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Commission # GG 017939
My Comm. Expires Aug 21, 2020
812/37
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CHRISTINE J. CON`�����}�
Nary-Pnbnc - State orlUa
Commission # GG 017839
Comm. Expires Aun 2t 2021
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