HomeMy WebLinkAboutBuilding permit appALL APPLICAS E IN�0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: cJ 1 a_Lw Permit Number:
I'M
i:� Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 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
oannncen 1NtPRnV7=MFNT LOCATION'
Address:
Legal Description:
Property Tax ID #
Site Plan Name: _ _ _--
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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Lot No.
Block No.
--ONSTRUCTION INFORMATION:
iti a or to e e orme un er t is permit— c ec a ❑ Windows/Doors
HVAC Gas Tank ❑ShuttersGas Piping �j
(�j ElGenerator L d Roof
Electric � Plumbing L,JSPrinkters
S. Ft. of First Floor:
Total Sq. Ft of Construction: OQ
`�,2 � Utilities: Sewer�Septic Building Height:
Cost of Construction: $ t i ✓ Oy
CONTRACTOR:
OWNER/LESSEE
NName:
ame t Qir (Rs�iRVlrf4/ �P�
-n„ I n r.ne Company: —n 1
State:
Zip Code: _
Phone No.lb =
Fill in fee simple Title Holder on next page) if different
from the owner listed above)
construction is $ZStNI or more a RECORDED Notice
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City: �b— Refc&_ State: _j�
Fax: -7 14 :3Ml
Zip Cade: 1 0
Phone No. LEO
E -Mail'
State or County Licen e: C.A6181Z3i 8 tp
is required.
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in considera-don of the granting of this requested permit 1 do hereby agree that 1 vAH, in all respects, Penn the work
in accordance mirth the approved plans the Florida Widing Endes and St Lurie Celmty Amendments -
The fottovaing building permit applications are exerriptfrom undergoing a full rnncurrency review. room additiorm
accessory Structures, s>rrinunutg polls knomwatts sus ween roams and aoms_mry ries to another Cron -residential use
° NI MG TO OWNER. ymw faflure to Record a lie of;Grrerimmmnent i tay re suit to Vow payi'stg wee for
-impreveslents to your property. A Notice of Commencement- t- must be retarded and pasters on the jobsite
before the first inspectiatn- ff you intend to obtain €trtancirsgf consort with tender or an attorney before
111V VA WX
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STATE OF FLORLDA
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COUNTY OF -5t.
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2010 by
Molo,j IF r.
Name of personAtawigstmement
pers} fRpro . - T { -rail
Type of identification
Produced,
(Signature of Notary
Notary Public - State of Flonc
�Goods onCoorlm , #�17
ational Notary ANotary A!
IM
COUNWOF (ML
CHRISKNE J. CONWELL
>tary Public - State of Florida
Commission # GG 017839
I # 4 ' $R
Name.
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MORTGAGE it
Name:
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in considera-don of the granting of this requested permit 1 do hereby agree that 1 vAH, in all respects, Penn the work
in accordance mirth the approved plans the Florida Widing Endes and St Lurie Celmty Amendments -
The fottovaing building permit applications are exerriptfrom undergoing a full rnncurrency review. room additiorm
accessory Structures, s>rrinunutg polls knomwatts sus ween roams and aoms_mry ries to another Cron -residential use
° NI MG TO OWNER. ymw faflure to Record a lie of;Grrerimmmnent i tay re suit to Vow payi'stg wee for
-impreveslents to your property. A Notice of Commencement- t- must be retarded and pasters on the jobsite
before the first inspectiatn- ff you intend to obtain €trtancirsgf consort with tender or an attorney before
111V VA WX
MAE
F..1
STATE OF FLORLDA
u ( I
COUNTY OF -5t.
wr ,. i i.
2010 by
Molo,j IF r.
Name of personAtawigstmement
pers} fRpro . - T { -rail
Type of identification
Produced,
(Signature of Notary
Notary Public - State of Flonc
�Goods onCoorlm , #�17
ational Notary ANotary A!
IM
COUNWOF (ML
CHRISKNE J. CONWELL
>tary Public - State of Florida
Commission # GG 017839