HomeMy WebLinkAboutBuilding permit app.LL APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_D11 J 10 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
PROPOSED IMPROVEMENT LOCATION:
Address: -VAS-7S�Q,/IIGyh }R,Vtr lxyi h' N 3LM51
Legal Description: 20(40-Firio S�nDY 5 ^ p�tQSQ. 2 LOT 320
Property Tax ID #: l31 A — 502 - 014Ll - 000 -3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
byl l5 sfEK Abp .s�.�. llm id
d YVI) hecc.
-CONSTRUCTION INFORMATION:
L-YJHVAC L J Gas Tank "Gas Piping
11 Electric ElPlumbing ❑Sprint
Total Sq. Ft of Construction: LL ,,.�tt�� ,nn��
Cost of Construction: $ 55i6o. 0
ars L _I Generator
Sq! FFtt_, of First Floor: _
Utilities: Sewer Septic
Windows/Doors
0 Roof
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name: 1
Addres3:l!L
Company
City: IL ifTe State:_
Zip Code: U00 Fax:
Phone No.
Address:10�A7FU lOLL
City: Wbr pitfc s State:
Zip Code: S 44 51i Fax: -71.�- 4&0-373-7
Phone No,- "(A- 4&J-414-1
E -Mail:
Fill in fee simple Title Holder on next page ( ff different
from the Owner listed above
E-Mail:hD�/i rtP Cfi (Yi
rtn%(IO.
u
State or Col n ty Cicen § e: ^ 1 I S IS 1'8 (P
_. _____ _. ___ __..-.. ...- .vn rvuuw u, a.umme... mem: is requlrea.
a
SUPPLEMEN-1,41- CONSTRUCTION UEN IAW INFORMATION:
€ E IN
Name,
_first Apo icab
OR ANY _ blot Applicable
Name:
Address:
STATE OF FLORIDA
Address-
City:
Zip_ Phone
State- _
Caty: State:
Zip: Phone:
FEE SIMKE TITLE HOLDEEk�
Name:
Not Applicable
BONDING COMPANY: Not Applicable
Name,
Address-
this j`# -day J1&2tl?A by
Address:
Cub -r:
�o€t
Iv�rchaeA -F So, ie,
ie,
City:
Zip: Phone:
Name of person/ialdng stAtement
Zip: Phones
Eolj,,
rr,
such
In consideration of the granting of this requested permit i do hereby agree that I wig, in all respects, perform the work
in accordance with the approved plans, the Florida Building Endes and St. Luck- GmundyAmendments-
The following building peanut applications are exempt from undergoing a full coneurrency, review room additions,
accessory streuhares, svrnmrurg pooh fences, watt ;Vis, semen rooms and accessory uses to another- ncr"eWen6al use
WARNING TO OWNER' Yow failure to Record a Notice of Commentawliew m. -y result in yaw paying tedice for
improvements to your property- A Notice of Ccsrr mencement must be recorded and posted on the jobsite
before the first inspection- If you intend -to obtain financing consult with lender or an attorney before -
commencing work or recordine your Notice of firrrunr=ncPmans
--�la,�.,� `•�.C1 -----
--ire-,�2�.�/ y�
4
Signature of ownerl Lie)tontraetar Ag t for nes
ire of ContractorAicense Holder
STATE OF FLORIDA
STATE OF FWRIDA I
The fogring - entwas admowledged before me
The � ming instrument was before me
this j`# -day J1&2tl?A by
this l5F day of JW QQ , 20_0 by
�o€t
Iv�rchaeA -F So, ie,
ie,
I&W C &yam
Name of person/ialdng stAtement
Name of persoginsta nt
PersonaSy Known OR Produced fdentiiication
Personally Known u 4RgProduced idernifitation
Type of Identification
Type of Identification
Produced
ProduceLd!
' -lopy
{Signature of i s NWELL
;Signature
Notary Pue of Florida
Commission No. '-• . : •2 Commis017839
`;�,
; ira•>GB•,, ELL
£emm�sgo _ Notary Public - State pf Fliir
tan # GG
;Expires
• °•' My Comm. ug 21, 2020
Banded throuNotary Assn.
„My Comm. Expires Aug 21, 2020
. °,..Bonded
through National Notary AssnREVIEWS
FONT 2DIIIISUPERVISOR
PtAN5 VEGETATI SEATURTLE MANGROVE
COUNTER REVIi-REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev-812/17
�j
i