HomeMy WebLinkAboutBuilding permit appALL APPL/I- BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (( ,zD
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 CommercialV/
Residential
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: gO 7 �` �O"I�Gt+ tVA [Ta iQT(Q MSM
Legal Description: Lbt.FG 000( FMI�, - UMW- ID . B(k. I2I ) !if '7�7
Property Tax ID#:_lS01Qn-000_-0
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
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WCTION INFORMATION:
riVAL L Gas Tank
Electric ❑ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $_ 14500.00
Lot No.
Block No. _
Piping U Shutters U Windows/Doors
nklers Generator U Roof
S Ft. of First Floor: _
Utilities, Septic
OWNER/LESSEE: CONTRACTOR:
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City: J111 V(U LC State: _
Zip Code: —a5r�� Fax:
Phone No.1 11- 4t 1 -
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Ni
Company:
Building Height:
City: M( -t:;' K e c& State: R-
Zip Code: '31{ Ej 5 1 Fax: -77,�-- 4t4-373-1
Phone No. - "[ - qp%-t. 14-t
E -Mail: yIQ11A tIn (?dl?. P -n ft i
State or County LicenSe: C%IZI$($ (p
If value of construction is 0500 or more, a RECORDED Notice of Commencement is
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Address:
City:
ZIP- Phone:
Address:
Oty• Slate:
ZIP: Phone:
BONOM COMPANY: FA € f pp4icable
Address:
City:
ZIP. Phone:
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The following building permit aPPlicafions are exempt frasn
accessory structures, swiis>nn poot=2 fi�� wa eHuiergoiag a full mncon CY review: room additions
sgns screen moms and accessory uses to another non-r(mdential use
WARNIPigments ¢ To R= VOW €tsy. A to Recce a e ai�.s result in VOW Paying mice for
before the first i y Property. A A7oiice of ComTnencennent rnisst be recorded and posted on the jobs! -Le
inspection. if yon intend to obtain financin& consult with tender or an attorney before
ct end g work orrecordintr your ivn;H a ^f
CarifinissiQa-,io�""F°i CHRISTINE$ ELL
N ublic - $ta Florida
F�- CommIssron #
My Comm. Expires Au 07 f839
REM FRON Ts
osg National Not rypssn.
COUNTER I R REV#E{fif
Rev-
SIME OF FLORIDA
The &�g in�g instrutneuF was ac .owtedged before me
this �1'rldaytgo�f : j1V1p Z0p by
W 4 i
Name oPeTSf R� akasg stat, sent
Personally Known OR Produced Identification
Type of identification
Produced
CHRISTINE J. CON(yL.4l
Notary Public - State o1 Honda
Commission # GG 017839
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