HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 l,14W __ Permit Number:
Building Permit Application
Planning and Development i 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:
atim
Ryd
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Legal Description:GnIAM
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Property Tax ID #: 2� - 0025-000 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
SSW( new
(,Lrut w� Io K,0 kla-
riCONSTRUCTION INFORMATION:
iti a wor to e ne orme un er t is permit- c e a app
HVAC GasTank []Gas Piping _Shutters Windows/Doors
Electric 1:1 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction:' ( S Ft. of First Floor:
Cost of Construction: $ 3�(w.00 Utilities: DSewer I --Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
0A 2
Name:
Address
LSY NL#,
Company:
i
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City: D 0 State:f;l_
Zip Code: 3 0 061 Fax:✓
Phone No.+UW*, &M � �
Address: 5i0Pr (fYiPf(ClL
City: fU' (�Rerce, State: R,
Zip Code: S0,51 Fax: -7?� 4&0 -373-f
Phone No.-r19- q:Of -414-1
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E-Mail: 6 4�- �J�"l-
A-50
Fill in fee simple Title Holder on next page (if different
E-Mail:
_
State or County Licen e:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEAMINCALCONSTRAMMINf
Address.Address:
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State-,
CitT- State:
Zip: -phigim:
Name:
Na
Zip: i
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Owners Associsarldon and reviewFI!Tf : s aY
;in considerallon of the gr2nwg(yf this requested permit, I do hereby agree that I will, in all respi perform the work
In accordance with the approved plani Florida Elialffing Codes
_ a. r exe -review.
>-ssory followingstructures,
_ tr. Y. pools,fences.waft, ♦_� ` - tl a accessory to another 'J t" Y. 4-
4. lot
> } " - t ♦ vY F is > i >
a Onamer�ODntractOr l entfor'umer
Signature Of COFMaCtMltsCEnseHolder
a �.F
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�f101R s 1 e,
COUN
The wiorg�ing inswmentwas admowledged Se#aae me
ZO
Tice pqi�ing instrument admawledged hefore me
this 2zrAday %�u' r, ZOZo by
tfais kWday of ry l r 20 by
of
MjyeA . Riyile.
Micw t F
Narreof 'rrg stilidwrtent - - --
Name of perscyfteift
Personally Known OR Produced identification
Personally Known VOR Produced ld�Ftifrcation
Type of ldeniHkation
Type of identification
Produced
Produced
{Slgt'eatute Al ,, ' 515�1 P WELL
:+ n- Notary Public - S e Florida
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; r } Notate ublic - WELL
• ° Commissi State. of Flori 1}
Commission •- Co 'ssion #�/n39
:� o¢ My Comm. Expires Aug 21,1020
m. Ex Aug 017839..
Bonded 21, 2020
Bonded through National Notary Assn.
throu n _
9h'+ational Notar
REVIEWS
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SEATURT€E
LMNIGROVE
COUNMR
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVEf)
DATE
COMPiEfED
Rev.8/2IT1