HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLW� INFO M UST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date: Permit Number:
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: '6505 wilviftr nP{2�Pin pku)u !. r lr(� iP P 3051
Legal Description: La4wooA I"�G(,fIC, -(,( t+ a , 1,Fr , Itob IDT5 (q a 22
Property Tax ID #: l3 J-GI -0109 -DDa -Ca Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
UI� liku:insfa %t%tAr Lurim Ile sEeiz kLc, sifstewl
W h
CONSTRUCTION INFORMATION:'
LvjHVAC I _lGasTank
Electric n Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3800.00
Piping ��_''jj Shutters a windows/Doors
nklers LJ Generator Roof
Ft. of First Floor: _
Utilities: _Sewer 0Septic
Building Height: -
OWNER/LESSEE:
CONTRACTOR:
Name
on
Name: W
Addr.e�ss::a"/ 0 VIfC((}Qy�{{� P104
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Company: r + Yt 12
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City -ha, YI ��t ap" tate: r&
Zip Code: 34151 Fax:
PhoneNo.Ha,' Sig-DO63
Address:510 h -rU 109i((¢ ri�pyl
City: fb(-b— efC& State: R_
Zip Code: '3+g51 Fax: -71a2-4&0-373-I
Phone No. - (-i• 1+1
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner fisted above)
E-Maily1 E2ylf koo. CA In
State or County License: CAC, I S 1313
11 vmue as uun vam is 4 w or more, a mmmn u nonce or commencement is requlrea.
Name:
Andress:
Caw 5#ate'
Zip: Ph€me
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Address,
Phone:
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Address:
aty-, State:
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such
In consideration of the granangof this requested permft� I do hereby agree tha I vAfl, aff e
in res� perform th work.
in accordancewth - '-
r., _ exempt from.additions,
'l.F S cta 't:o l' k momundergoing cce - td`normdermatuse
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t f-. IS i E {. E.. + f. fY--^ a. -:fi i. _: 1F- _ Y' '-. fl•i f if1 - # ..tAike for
i
a - f - , .: �... s [ . i. �• s; � rt't# -' # r � f, . t • a,w.. #,' rf. _ '
The forgomg imstrapnent acimmuledged aehsre me
this 2S day of 1 .70 20 by
Bn iie.
Name of
Personally Knosmt OR Produced identiticatitxs
Type of Identification
Produced
(signature of
CHRISTINE J. CON(MWj
Mary Publk - State of Florida
Commission # GG 017839
Ef%ti4
adv_ R17/17
- CHRISTINE J. CGNWE(Qea
5rJry u is - State of Florida
Commission # GG 017839
National h-