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HomeMy WebLinkAboutBuilding Permitggg
ER{ D VIT: Phone -
Application is hereby made to obtain a gerezuf do the work and enstait6,ti€an as indicated.g
I certify thatno work or installation has commenced prior to the issuance of a permit
Slhg4eCouny maloesnerepresentation that sgranting apermit wiliauthorizethepennitholdertobuildiiesubjectstructure
wttich s in conflict with any applicable Hoare Owners Association Piles, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your de-ed many restrictions which may apply.
In consideration of the granting of it& requested permit i do hereby agree that 4 will, in all respects, perform the work
in accordance with the app plans, The Florida Building Codes a, id Si Lame County Amendments. t
The following building pem�[ applications are exempt from undergoing a full c ncurren y review: room additions,
accessory structures, s+a+rg pools fences, walls, signs, stceen rooms and accessory uses to another non-residentiat use
1 ARa`�iN€a TOO : Y lure to Record a Notice € f may rescan in your Nayingtwice for
improvements to your property. A Notice of Commencement must be recorded and posted on the }obsite
before the first inspection. if you intend to obtain financing, consult with tender or an attorney before
commencingwork or recordingyour Notice of Commencement_
i
t
i
Rev. 81-2/1? x
i
SUPPt.EN9€�FfAi_Ci� tiCTtOl1E ElEl�i I:i�i,��RtATTt#N_
DESiGNEIIJEidfiiPiEER: - _i+iot Applicable ti�iiRT�aA6E Alf: `toot Applicable
Name- Mame:
Address Address:
State: City: State:
Tip: Phone Zip:-Phone-
FEE
ip: Phona:
FEE SiR+6PIE TE£i€ Applicable
Signature of Cpntracior/ficersse Holder
Signature o� j tesseefContractor Agent for caner
Sf�iTE>�€FLORIDA t
Si3tlPii'1f `
STATE DFFL€3RlDA �I Qi
5�
{3F
COUNTYOF
The frtr�inghostru" was acorowledged beirue rrte
this day of 20 ZO by
The iorgoir� instrumeni was ackrwvrledge before me
ths]d�-day of AA nw - 20� 6y
F. boy le.
lC�.¢i F � !�
Name of person emenF
t\iameofpersir sta meat
Name:
personally Known QR P€ndttced Identification
fl� ,�pAl
Name:
i�t€it App€rcabie
Address:.
Produced
Address:
(Sigriatr-reaf it Slate of €lotida )
City:
city:
Zip: Phone:
[ip: Phone:
Comm
ggg
ER{ D VIT: Phone -
Application is hereby made to obtain a gerezuf do the work and enstait6,ti€an as indicated.g
I certify thatno work or installation has commenced prior to the issuance of a permit
Slhg4eCouny maloesnerepresentation that sgranting apermit wiliauthorizethepennitholdertobuildiiesubjectstructure
wttich s in conflict with any applicable Hoare Owners Association Piles, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your de-ed many restrictions which may apply.
In consideration of the granting of it& requested permit i do hereby agree that 4 will, in all respects, perform the work
in accordance with the app plans, The Florida Building Codes a, id Si Lame County Amendments. t
The following building pem�[ applications are exempt from undergoing a full c ncurren y review: room additions,
accessory structures, s+a+rg pools fences, walls, signs, stceen rooms and accessory uses to another non-residentiat use
1 ARa`�iN€a TOO : Y lure to Record a Notice € f may rescan in your Nayingtwice for
improvements to your property. A Notice of Commencement must be recorded and posted on the }obsite
before the first inspection. if you intend to obtain financing, consult with tender or an attorney before
commencingwork or recordingyour Notice of Commencement_
i
t
i
Rev. 81-2/1? x
i
SUPPt.EN9€�FfAi_Ci� tiCTtOl1E ElEl�i I:i�i,��RtATTt#N_
DESiGNEIIJEidfiiPiEER: - _i+iot Applicable ti�iiRT�aA6E Alf: `toot Applicable
Name- Mame:
Address Address:
State: City: State:
Tip: Phone Zip:-Phone-
FEE
ip: Phona:
FEE SiR+6PIE TE£i€ Applicable
Signature of Cpntracior/ficersse Holder
Signature o� j tesseefContractor Agent for caner
Sf�iTE>�€FLORIDA t
Si3tlPii'1f `
STATE DFFL€3RlDA �I Qi
5�
{3F
COUNTYOF
The frtr�inghostru" was acorowledged beirue rrte
this day of 20 ZO by
The iorgoir� instrumeni was ackrwvrledge before me
ths]d�-day of AA nw - 20� 6y
F. boy le.
lC�.¢i F � !�
Name of person emenF
t\iameofpersir sta meat
Personally Known �OProducerf Identification
personally Known QR P€ndttced Identification
Type of identification
Type of Identification
Produced
Produced
(Sigriatr-reaf it Slate of €lotida )
(Signature
,,..yP• CHRISTINE J. CON ELL
",
Comm
•'�`� Notary Public - St{tlorida
WELL
CHR TINE J. COM
;• a , •_ ommission # GG 61 839
z, Utary'Patrflc"3fate of Florida ,
=� a= My Comm. Expires Aug 21, 2020
Commission # GG 017839
'%`oF F`Op` I Nolar Assn.
_
o' ° M Comm. Expires Au 21, 2920
Bonded through
tional Notary Assn,
REVIEWS F;ti;Alf
ZLI�EiNCa SUPERVISOR
` P
MANGROVE
C(3iiNi� •
REvlEva REVIEW
REVIEW REifi!"Vft
iiEVfEi�€
REVIEW
DATE
RECEIVED
i}ATE
C6AriPtEFEQ
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S�7 %� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 v/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSE() IMPROVEMENT LOCATION:
Address:
t
&(V i Q�( 3 i
Legal Description: Cklld
p 11A II,,V
.P1 ?Uf V1ls K
PropertyTaxlD#: �l`3�3- ���' ©DZS Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
l,�ke Fpr U Vo a 5 -�m1, t µ s e,> R. UlAb Af le,
PktiaLit
CONSTRUCTION INFORMATION: .
ii a war to be ormed under tis permit- check all that apply:
HVAC Gas Tank ❑Gas Piping _Shutters jE]j WindowsJDoors
DElectric 0 Plumbing Sprinklers Generator U Roof
Total Sq. Ft of Construction,Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: 0Sewer OSeptic Building Height:
OWNERAESSEE:
CONTRACTOR:
Nam eDQ,y@i'OJ2LIP• ohtC S
Name:
Addresrs�:q1)"( NQ -1 / c VC
Company: ( fi
City: fYAMD �(! State: Ir
ZipCo'de:, '3306q
Address:510r Pr TLCfi'I ikg-
City: fb(-b— r-(-c& State: R,
TFax:
Phone No. +LlA1,t - ! D g Vlln CAt-
E-Mail: 5$'
Zip Code: .3 5 Fax: -7 IL 14 & 40 -3-13`7
Phone No.-rig- -414-1
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County Licen e: `i. " I'81731$
from the Owner listed above)
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.