HomeMy WebLinkAboutBuilding permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' IIO 1(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-iSS3 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
II
PROPOSED IMPROVEMENT LOCATION:
Address: -
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
('DETAILED DESCRIPTION OF WORK:
Ike- -�( 1-i kz '. yv,s-Fal.t Atu) 4 -bn P_uy-DI14 6OeA A ((2,
o at 4l uAit iul-1+1 MKV) hI&-
Lot No.
Block No.
CONSTRUCTION INFORMATION: 11'
LJHVAC L_J Gas Tank UGa!
11 Electric 0 Plumbing 0Spi
Total Sq. Ft of Construction: tW !
Cost of Construction: S `I a m
Piping L_1Shutters
=rs L ► Generator
S Ft. of First Floor: _
Utilities:oSewer OSeptic
Windows/Doors
aRoof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name(' J0 �50
Name:
I;
Address:-(Qj LaV110, q!
nn�
Company:Be�a1p_!Tt( i9) i{jQ NP1
11A
City: State: �C.
ZipCode: W5I Fax:
Phone No
.
Addres,.1510 Ei /rl�Iij(¢ �Op�(} —
City: Rcrc& State: r-L
Zip Code: '3 4951 Fax: -71.2 - 46 -373")
Phone No. -"A- i -+- 14-1
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
E-Mail: ��lG(L I InO. Cti (ri
State or County Licen e: ClFC I H 1-3I $ (p
•• --•-- •-•-�••-•• •� ,••.,•_, a ncwnucu •vouce w commencement is required.
i
O # INFORMATION:
1
Address:
C1W State:
Zip: -phone
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in consideration of the granting of this requested permit t do hereby agree that I wfiif in all respects, perform the work
in accordance with the approved €r$ the Ronda &MIng bodes and St tucte Count; Amendments.
The fallowing building pema"tt applications are exempt from undergoing a hall mncur.ency review. roam additions,
accessory sbuctures, svArn ing pacts, fences, wafts, signs. saeen rooms and accessory uses to ancither non-residet9al use
WARNING TO : Your failure to Record a Noticeof Conitmencement eta result in your gaping tiles for
impro mments to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the fist inspection. if you intend to obtain ra€ cing, consult with {ender or an attorney before
commencing work or recording Your Notice of Commencement
signature off0mer(Lessee%Coniractoe Agent for
Stnature Of Contrac#oritkense Holder
1
STATE OF RDRI 3A �
STATE OF A
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NTT
COUYOF
iQJNTSYEIF �l
The forgaing Instrument was admovAedged before me
The forgoing rostrum 'Wasadmowtedged before me
this day of SfA .20U by
this=dayofJ zu%a by
€aet F. Yioy(e�
Wc%eI F
Name of person/halft stiternem
Name of persoyinalding statilment
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of fde4atliearion
Type of Identification
Produced
Produced
y
(Signature of Nara ' ublec State of Florida)
of" P c-State of Horida d
Commission N ,gin •A;'•a ^"RISTINE ::� WELL
Coe ^'p>, CHRISTINE J.CONW
of State of
7;•. Notary Public - State oTFloritla
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' - Commission # GG 017839
- Commission # GG 01783
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21, 2020
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REVIEWS
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REVIEW
REVIEW
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REVIEW
[1ATE
RECEIVED
fiATE
COi1APLECED
Rev- 8j2/17