HomeMy WebLinkAboutBuilding Permit ApplicationAIIAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
Building Permit Application
Planning ond Development Services
Building and Code Regulotion Division
2300 Virginia Avenue, Fort pierce FL 34982
Phone: (772) 462-t553 Fax: (772\ 462-L578 Commercial X Residential
pERMtr rypE: L.leC-tf^i CAI
PROPOSED IMPROVEMENT LOCATION :
Address:
Property Tax lD ll:
Site Plan Name:
Project Name: 0tf0
Bloc
Lot l!o. 2
kNo.
-
DETAILED DESCRIPTION OF WORI(:
CONSTRUCTION I N FORMATION :
Additional work to be performed under this permit - check allthat apply:
_Mechanical
_ Electric
Total Sq. Ft of Construction:
_ Gas Tanl<
_ Plumbing
-- Gas Piping
_- Sprinl<lers
Sh utters _ Windows/Door:;
_ Generator _ Roof pitch
Sq. Ft. of First Floor:
CostofConstruction'$ lt5QD.oO Utitities: _Sewer _septic BuitdingHeight:
CONTRACTOR:
Name;
citv:\frqV-r\a-ncl beo_el,1 state: FL
Zip codel 331Sf Fax:-
nooress: 3OtS S. O(?Oft R\Vd,Com pany:
noaress: P.O Bt-.x JbbS
city: %(t t>\. LVC,e stcitv: tb(t t}\. LVC,e state:1fr*
]
Zip Code: 3\.\Q<5 Fax: - _--- i
Phone No -'l --l? - ek) - br:c<c.
Phone No.-
E-Mail: -
Fill in fee simple Title Holder on next page ( if different I e -Vait
from the Owner listed above)State or County Llcense
lf value of construction is $2500 er more, a RECORDED Notice of Commencement is required.
lf value of HVAC is 57,500 or more, a RECORDED Notice of commencement is required.
OWNER/LESSEE:
SU PPLEM ENTAL CONSTRUCTION LIEN LAW INFORMATION;
DESIGNER/ENGINEEK
Name;
Not Applicable MORTGAGE COMPANY:
Name:
I
_ Not Apolicabie
Address;Aodress.City:
Zip:Phnne
State:_,rI.
7it'State:
Phone:
FEE SIMPLE TITLE
Name:
HO[DER:_ Not Applrcable BONDING COMPANY:
Name:_Not Apprlicable
Ad d ress:Address:City:
zip:Phone:City:
zip:phone:
iil:f ii:il.,ud:l*f;i'!?i""{Jrji.'iaiJlf;:,Fb"ifrl?i!:ffi3:,s ;Jill,.SJi:?{i'i-ttqr:rn':t norder ro buird,the-s,rrb;ect srrucru13structLrre Piease consult with iour H.*J o;#;;'i'rscciation and a;i6;'i;;;8lfiF"?".""iiP{!?,T1il,{i,yri,:lrict d' b;ili Liii,in
:n consideralion of the granting of this requested per.nit, i Jc hereby agree that I wii!, in all respects, perform the workir accordance with the approved plans, rhe Flcrida Br-ilding Cedes and ir. Lucje counlv Arnendments.
The following building permit applications are exempr ircm undergcing a fui, concurrency review: room additions,6ccessory slrucrures' swimming poois, fences, walls, ; gns, screen ioois uno accessory uses to another non.residentiai use"WANM'{C TO O}ryNEft:,Jg9II-TALLURE TO NECORD A NOTICE OF COMHENCEilENT [rAY RE5ULT IN YOUR PAYINGrwlcE FoR IMPR'YEMENF ro Youn PK:RII---1 rlo1rc-u ir comurrucEmE*T MUsr BE nEcoRDED ANDPosr€D or4HE JoH'{a BEFoRE tfit$r tnspEcnoN. rr lou trurgltfTo oBrArN nNANcrgq',toNsurr- wtr+.66B.\Erywt{oR
^N
aygryydBE rGd;;;;ii,1't6r" Nor.n€
'F,T'MMFNTFMFNT
, ./ -/
OWNER/ CONTRACTOR AFFtDVIT: oool,..,*., h;;^* *,i certify rhat no rvork or installation has commenceo p.
",' ,.-,'r..,. ;;;;; ";: ;l;,i:
ereby erade to orltain a perm;t to do the work and installation as rrclicated.
Signature of Owner/ t-esseeT@ SignEtu re of ContractorfLlense Holder.
STATE OF FLORIDA <-,couNTyoF )h" Lrrf re_
Tne forgoinE
trris dQ aay
STATE OF FLORIDA C-\
couNTY or .'tY. Lr rer P: _-_.
/personarry Known _+1* oR produced loentrficar,cn
' \,pe or lcerltrlJcatJon
Produ ceo
Narne of person'm-aking statement.
{5ignaiure of Norary pub
Conrmission No.
i\a1te ct oerson maklng stater
,/'
Perso^ar.y l(nor.,irr - y' On
Tyoe of identiiicarion
P !'cC uceC
aiurc of Notarv Pubiic- State
rSSlOn \C
Produced ldentification
REV|EI{IS ,rnorvr ito*,*o
: COUNTER I REVIE\^J RIVIEW REVIEW REVIEW . REVIE\^I
supERvisoR PLANS VEGETATTON I Senrunrlr i ,vnlrcnouEREVlElv RivlEw REVTEW I Rrrrrnri o.,,i.iii-'
RECEIVE D
DATE
COMPLETED
nffi,Kev.tl/tI9
fJame ci inaklng statement
rr4YcgMMtssloN # cc 970043cc
'HFiRES: March 16.2024
Bonded Thru Notary Pubilc Undsnnltg g