HomeMy WebLinkAboutBuilding permit appALL APPLI,I- BLENFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I( 1112-0
Permit Number:
�y
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 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 line
PROPOSEDL
IMPROVEMENT OCATION:
Address. I YR0 Al S lir .I I n"I 9 , In I
Legal Description:
Property TaxlD#: lI0025 -000 /5
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
atIAILED DESCRIPTION OF WORK:
L't k.2, rUke -` S�u,6l n�u 3-lvi� N s
INFORMATION:
Lot No.
Block No.
Left Side:
u �C ackak- Unit
I MHVAC L J Gas Tank "Gas Piping Shutters F'jj
�(WindowsJDaors
Electric ❑ Plumbing OSprinkiers 11 Generator �(
L� Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ �i goo. 00 Utilities: _Sewer Septic Building Height:
OWNER/ESSEE: CONTRACTOR:
nim.,,,, f)O�LIAi,nn NA_Intin IL_-- c .__
City: 0 Pjp[iI (n State: _FL�
Zip Cod'—_ Fax:
Phone No.-rnan 614rI X 13-1(a�47"
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company:
c
City: MQ� i`I eft& State: r
Zip Code: _'3 ij E{ 5 } Fax: -77,,7-- 4&(p -373`7
Phone No. - _ 4( 1
E -Mail: ((p�° �r llrzl�lnCT. airs lri
State or County License: CA<,' 181818 (p
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
FEE SIMPLE TITLE 'E;3: Nast: `J4 -r.X
Addfew-
iso:f zr a Li Fl
MOR76AGE COMPANY:
'd _
ante:
cit Applicable
Address
City= state:
Zip: Phone:
afX _t
J -
t i L. r.:i. iaf ti � i -i 1 iL 03 i'i • L i _ iT. I •: —
1 -J
IS`
�� —'Yj �`}X• lcocns is nuco L lay apply.
consideration of the grartirg of this requested permit, € do hereby agree that I wif€, in all he r•r=,'•
io accordance with the approved Flans,the faorida Buf1dmg Codes and St Luc,,, . Illy honer d�respects the work
ace f1llow109 building permit applications are exeurPtfrom undergoing a full concurrency review: room additions,
cessory stnrchm's, swiounoW Pools, %rtes, waft, sirens, screen rooms and accessory uses to anothernnn-residential use
WARNING To OW E& Ysausfaffure to Record a Notke of iso _ zt resent in exus ,
-irTiProvements to your Properly- A Notice of Commen€e€neiitiinust be recorded and :tee for
before lite first ins posted on the jobsite
pection, If intend to obtain financing, consult wifft'ender or an attorney before
commencing wont or recordirtl?raitsr lucriir Q retrnL. i. n .
Stnature0l'unUaCtOriticenseHoleter
CDMASsim No. (Seal)
CHRISTINE J. CONWELL
Rev.
The IbIgGirg h1strument was acknowledged before me
this f. 4_ZWA..201A by
"
Nante of
Pam
*X ..f
Produced Identffication
Type of identification
Produced
-Cnmrnt55iOn.•`iWr P�.i, CHRISTINE("-2Assn,
�o'-__-�'Nbt3ry Public - Stat
•? Commission # GG
Q,
•"a "°� Bonded through Nationa
' FQ 91, 9020
FIs
REVIEW REVIEW REVIEW REVIEW