HomeMy WebLinkAboutBuilding PermitALL APPLICABLE 1 If0 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 30 7 Permit Number:
m
Building Permit Application
Planning and et5ervkes /
e Regulation Division
Building and CododRegulation
2300 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
PROPOSED IMPROVEMEI�/l�T,
Address: 15o
,LOCATION_
�C Q' l ��f C% 3 Liar
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Legal Description:_ LA kpw 1R
&rL - LWit
4 - Blk3q r Lots a-s ti
Property Tax ID#: I?OI -�PO`i QZZ�' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
-For L eke,; Ll neW LermN 3 bn I V sl W�
S?�it- k[c' sftm wig to KO h&t-
CONSTRUCTION INFORMATION:
c ec a apply:
a wor to e ne orme un er this permit -check
iti (
_ XHVAC L__I Gas Tank Gas Piping 1:1^ Shutters a Windows/Doors
Electric El Plumbing Sprinklers 0 Generator O Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ on, 00 Utilities: 0Sewer 1:1Septic Building Height:
OW N ERAESSEE
CONTRACTOR:
Nam _ �Y1Ok'rtg }C 11
Addres : -75
City: p -CM (c t State: �L-
Name:
Company: 1( J i � flaflnq
'-FAC.
Address: 5I0 6 P. In l2ibe- j;i�
Zip Code: 34A-)l Fax:
City: N-b—Rffc& State: �C
Phone No. 7-7'2' 415 ..3� 2 1p
Zip Code: S 51, Fax: -77-�-' 4ble-3731
E-Mail:
Phone No. -"A- 4-IW-414-1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:6.14f F1.L@.0 VAI)o- Cif 01
State or County License: C1tC 18 l I $ 1p
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Address-
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structure. Please consultwitsVaurHome r sAssociatanandreviewyou€deeotoranyrunswratninayapply
In consideration of the grasungot this requested permit t do hereby agree the I will, in ail respects, perform the work
in accordance withtheappmve d plan-, the Florida &.0ding Cordes and St tune County Amendments.
The following- building permmt applications are exempt from undergoing a trill c oncurrency reidew: room additions,
accessory structures, swimming pools, ferrces, walls.sgnsi� sueen moms and accessory rota another non-residential use
WARNING TO OWNER: Your faillure to Remrd a Notim of Commencement inlay result in you paying twice for
improvements to your proper 4} A Notice of Cornmericenlent most be recorded and pouted on the jobsite
before the first inspection- if you intend to obtain financing, a msuit va-th lender or an attorney before
commending work o Notice of Commencement
Stgrtature of er ContracterAmense Hold
Signature or Owner( iessseeejContractor' s A(g�e�nt tar
SSATE QrEt3R9STATE F i)A JT. �e. � U(
Cmiin€s: iif
COUNTY tflutvey FLORIDA
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The for ang instrumentwas admowkx4ged before me
Thefurgoerg instrument was acissmwiedged before me
this day of,T� 20,U by
t day of _ 2O 20 by
chc+el 7 &-y le,
Wdlmu F. Boyle,
Name of persm/.aftstAtement
Plante of sta t
W7fon
Personally Known OR Produced Identification
Pets onally Known Produced €daatilication
Type of ldeafiftcation
Type of Identification
Produced
Produced
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Commission Plo_ ; <!�` �`'-. CHRISTINE JOYCI%M2Assn.
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Comm. Expir
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L .; otary PubliC - State of
.a `= Commission ff GG 984My
My Comm. Expires Aug 21roug
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REMEW REVIEW
DATE
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DATE
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Rev. B(2f17