HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
Building Permit Application
Planning and Development Services
Building and Cade 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 fine
PROPOSED IMPROVEMENT LOCATION: 11
Address:_71qt
Legal Description:
Property Tax ID #: 1301- W5-012 8 -000 =1 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: III
L_VjHVAC I IGas Tank LJGas
0 -Electric 0Plumbing ❑Spr
Total Sq. Ft of Construction:
Cost of Construction: $ 5200 • Da
Piping LJ Shutters
nklers 0 Generator
_
SQ. Ft. of First Floor: _
tJtilities:Sewer Septic
QWindows/Doors
Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name l
Address: PCU L
City: I l` . _ Stat _
Zip Code: 3 51 Fax:
Phone No.'I'( orli�j
Name:
Company: z
Address:510 6 Pr _&M fff t.2- rr.9l
City: � I7(e(G& State:
Zip Code: -34q5 I Fax: -77.7-- 4&0 -373-7
PhoneNo.-"9L- (_414_1
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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State or County Licen e: Q,0,111'913
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
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in consideration _1 .i i " 1 thisrequested perrini I do herebyagreethat tit-•{, perform:'i
in F. - - _ Y -Codes• SY -
The
rtitEstructures,- z•t.efences, exempt
tWi screentaa- i- n tss_ .idential use
WARNING TO 011111MM, Yew bilwe to
a Notice of Corialitumcernerd:
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The IF ftrs�entwasacknowledgedbefbreme
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Name of person/haildlingstlitement
Penonally Known )Z OR Roduced Identification
Type of _ i : xs
r RiaTiNE J. (ASMWc
Notary Public - State of Florif
Commission # GG 017619
RE'VIM
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Rev- 812117
The forgoing i
this11- day
LINE
acknowledged before me
.24? by
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;n2ii3reofiy.... Sta��%ioricla}.
T CHRISTINE J. CGNWELL al)
e of Florida
-(; Q�;1•=- Commission # GG 017839
Assn.