HomeMy WebLinkAboutBuilding permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date: I a �ZC�
Permit Number:
' Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fart Pierce F! 34982
Vs/
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:
((e' 34q 1,(.5
Legal Description: O it& 4nm P
Property Tax ID #: - 0025-0(a/f
Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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W1% 1Q KW head .
CONSTRUCTION INFORMATION:
rt1 a wo to e e orme un ert �s permit -c ec a 1 app
_HVAC Gas Tank [:]Gas Piping _ Shutters Q Windows/Doors
11Electric n
Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
P"
Cost of Construction: $— �ly�f Q./%b Utilities: nseptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: ISf-
Company:p•.�_iTl(' TYk�jt(Q`��", � /iplTr1C_
Address:/o 6i'-4rf,pik-L �PlrilF± it .
City:pQNL{1lLflfJ B4/f/(1 State: �
City: b(� (7(QfGQiState:
Zip Code:g,3 n/ocl Fax:
,1^
Phone No.(ZfIRrL4-' &J6NQSSC( 30�F 839 /$Q[{
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Zip Code: '3 5i Fax: ??.2-iI -373`1
E -Mail:
Phone No.- g- LNOJAW
Fill in fee simple Title Holder on next page I if different
E -Mail: /( 111a )7(7n, Co (n
from the Owner listed above)
i/n
State or County License: C A'0' 18181$ (y
If value of construction is $2500 or more, a RECORDED Notice of Commencement
is required.
•'Ji i Y1 �Ftf lfi iii f. ii# 41 I.. t♦i-
T
ty'ANPI'Miril Is - - 9� M
iavyourdeed mranyrestrictions which may apply
In consideration ofthe gr if of lus requested pennit, I anpen hereby agree that - 1 perform the wm'
m accordance with the approved plansthe Florida litutding Codes and St tum County Amendments.
The following building permit applications are exempt from ur4ergoing a full concurrency, reldow- room additions,
accessoryt i pools, 1 a signs screen f tms and accessoryIl'to anothernon-residential
APAING To OWPIIE& Youriaffm to Record a Madmolf£tBoc my resulthi your payftiigmice €or
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
i Xe the forst inspection. if you intend to obtain finaincingt consult Y&h lender or an attorney before
commeridingworkorreoording ur Notice of Commencement
SigraaL ec dhmer'ICz a/Cnniractnr for u er
S*eattusea€ContracturAkenseHolder
NTOYQF RDMDA �.CI�COUNTYOFS}i
3 E i a13
flSTATE
�' i�, y
Thensstrumentwas acknowledged before me
ihis� of- JW!j 20 20 by
Address:P
� diQFii )de,
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yam-
(C% C
Imarne of person/haldog stlitement
Name ofperscyinalft statalment
Cdy--
t -Phone
State:
Type of Identification
Type of Identification
Produced
Produced
<zv&/—
(SignatareofN6 - F6 }
(SignatureofNotam ofFlmida)
, unla
RI$�I CONWELL
,, fta
Commissf°° Rto_ '' o �"��° Ply(.
y c - State
commission- iElo. �ra °�'•,� CHRI CONWELL
Notary
_, e of Florida
± d Commission #'GG 011839
_ - P Alio . State of Florida
oc Commission
s..a, F4eo-,. My Comm. Ezpires Au%:?�
_ # GG 071&39
t,o' My Comm.E"
e rough Nal
nal Notary Assn
3 _Phone.
onded through N
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REVIEWS
•'Ji i Y1 �Ftf lfi iii f. ii# 41 I.. t♦i-
T
ty'ANPI'Miril Is - - 9� M
iavyourdeed mranyrestrictions which may apply
In consideration ofthe gr if of lus requested pennit, I anpen hereby agree that - 1 perform the wm'
m accordance with the approved plansthe Florida litutding Codes and St tum County Amendments.
The following building permit applications are exempt from ur4ergoing a full concurrency, reldow- room additions,
accessoryt i pools, 1 a signs screen f tms and accessoryIl'to anothernon-residential
APAING To OWPIIE& Youriaffm to Record a Madmolf£tBoc my resulthi your payftiigmice €or
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
i Xe the forst inspection. if you intend to obtain finaincingt consult Y&h lender or an attorney before
commeridingworkorreoording ur Notice of Commencement
Rev- 812117
SigraaL ec dhmer'ICz a/Cnniractnr for u er
S*eattusea€ContracturAkenseHolder
NTOYQF RDMDA �.CI�COUNTYOFS}i
STATE OF FMRIDA
Lucie.
flSTATE
Thensstrumentwas acknowledged before me
ihis� of- JW!j 20 20 by
The forgoing instrument was admowledged before me
this3j�fdayof 'Tu 20 20by
� diQFii )de,
`'
yam-
(C% C
Imarne of person/haldog stlitement
Name ofperscyinalft statalment
Persscanally Known DR Produced tderzE�ation
Personally Known LIR flmduced Identification
Type of Identification
Type of Identification
Produced
Produced
<zv&/—
(SignatareofN6 - F6 }
(SignatureofNotam ofFlmida)
, unla
RI$�I CONWELL
,, fta
Commissf°° Rto_ '' o �"��° Ply(.
y c - State
commission- iElo. �ra °�'•,� CHRI CONWELL
Notary
_, e of Florida
± d Commission #'GG 011839
_ - P Alio . State of Florida
oc Commission
s..a, F4eo-,. My Comm. Ezpires Au%:?�
_ # GG 071&39
t,o' My Comm.E"
e rough Nal
nal Notary Assn
onded through N
Tonal Notar
REVIEWS
FRONT
PLANS
V€GFTATIUN
COUNTER
REVIEW
REVIEW '
REVIEW'
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
BATE
1
COMPLETED
I
Rev- 812117