HomeMy WebLinkAboutBuilding t permit appA
COMPLETED FOR APPLICATION TO BE ACCEPTED
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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III i 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:
A(C rxr fc�( "(+- ruiih 101-6 H?cL
Lot No.
Block No.
CONSTRUCTION INFORMATION: III
HaaMu nal worrc w oe enorrnea unaer uus Perrnu-Lr
_HVAC Gas Tank [—]Gas Piping
11 Electric FI Plumbing nSprinl
Total Sq. Ft of Construction: �1 �l
Cost of Construction: $ U! 0 V - U v
ors L I Generator
5 Ft. of First Floor: _
Utilities:n Sewer F Septic
QWindows/Doors
11 Roof
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
tlnmt,Name:
&AUL14
Address: ( 555 5pWi5l1
LaUb BIU
L7
Company: )yh,_ Ai(- Nn4iliQY1t1/A/A'uplift
Jfle_
City: 2�C� State: r
L
Zip Code:-51 Fax:
Phone No. Sn10- 3 Lf-q ^ Sir�!! LiS
Address:-5106 Pr _k MIY(kfG. �pP�tt?i�i J r
City: fb(-b— I trc& State: r-L
Zip Code: S +A 5 1 Fax: -71-7' 4&(o -373-r
Phone No.— (9-- WoI-414-1
E-Mail:
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E-Mail:VAVf QL6,1
State or County Licen e: CAC, 1'8 IS I Z IP
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCON-SMUCTION UEN LAW INFORMATION:
DESIGNE8jfMMEER.
Name:
_ Not Appikable
Alf R76AGE ANY_ _NotApplicable
Name:
Address-
Address:
City:
Zip: Phone
State:
Csiy: state:
Zip: Phone:
FEE SIMPLE THE HOB
Name:
y Not Applicable
BL?iV MNG ANY: Not Applicable
Name -
Address:
Address:
City_
ow.
Zip: Phone:
Zap: Phone
structum Pleaseconsultwar.ycsw momei21A1lSersP.:x6E43II'3ri armor reuriew you€eaen awy.
In consideration of the granting of this requested permit I do hereby agree that I %AH, in all respects, perform the work
in accordance with the approved Plans, the Florida Bukring Codes and St sucie County Amendments,
Thefoltoyaing building permit applications are exempt from undergoing a full coneofrency reviear room additions,
accessory structures, SW-smmang pools, fences, waits, signs, screen rooms and accessory uses to another non-residential use
WARNIM TO OWNE& Your failure to Record a Notice of Conrrnencemem may result in your paying traice for
improvements to your property. A Notice of Commencement most be recorded and posted on the jobsite
before the firms inspection- if you Intend to obtain financing, consult mrith tender or an attorney before
commencing work or recording your notice of Commencement
e :;ell
Signature of`CordractorfLicetseHolder
Signature orOvmerlitsseelCorruacmr Agent far r
STATE Lfi�
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The forgoing instro twasadmowledgedbeforeme
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Name of perswVhairing stitement
Name of pi
Rscat ilment
Personally Known OR Produced Identification
Personally tf ------ V
OR Produced Kier on
Type of Identification
Type of Identification
Produced
Produced
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(Signature ofN Iic-StateofFlorida)
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5tateoft�errida}
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commission No.
f. s No_
TI A WEL
CHRISTINE JOYCE CGNWELL
Florida
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No u •-State Flo a
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984701
nctary Publi£ •State of
GG 984701
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev- 8I213-7