HomeMy WebLinkAboutBuilding Permit ApplicationPermit. Number:
RECEIVED
Building Permit Application
Commercial, Residential
Electrical, Meter
this permit = check all that apply:
Gas Piping Shutters
—Sprinklers —G . enerator
Lot No.
Block No.
Windows/Doors Pond
Roof ar Pitch
Sq. Ft. of First'Floor:
Utilities: , lities; -Sewer —/Se'Ptic Bu-ildirigH.eight: -13�iFl
State.: rL
[I APD t AM f L1.CAB.LEJNF0-'-MU4Tr BE'C;,,VAE"TED. F0117APPLICATION TO-13t, ACCEPTED
Date:
Planning and Developmentsdrvices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3
Phone: (772) 462-1553 Fax: (772'
Address:
Property Tax [D#:
Site Plan Name:_
Project Name:
New electrical: Meter V-**'
Additional work t0,be'perfdrMed - t
mechanical Gas Tank,
v/Electric
�lurnbing
Total Sq. Ft of Construction:
Cost Of Construction:
Name -
Address:
Cit
Zip'Cod'e: qALNl Fax:
Phone No. *7"M- 24,0 -36
E-Mai. V
Fill in fee
from -the 6 11
If value of
If value of
Namet (7)
.411" 11 ..... .....
Company:
LLC.
Address: 6
C t
Y' Rc Loc
State;.
Zip CodeFax:
Phone No S:4- 1 '6
E-Mail
CJP
State or County Lic nse
is required.
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Zip: Phone
FEE SIMPLE ----� TITLE HOLDER: moz*pp/�uu=
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AddCity:. Phone:
ORTGAGE COMPANY:
Zip: Phone,
BONDING COMPANY: --,-Not Applicable
Zip: Phone
OWNER/ to - NTRPiCTOR AFFIDVIT: Application is hereby made to obtaln,a permit to do thewos
.
-itatibri,that is granting a permit will auth" 6ts that may restric(Or pr hit
asA�ent�xWwner
|� \ S�natureorune/^e""~~ Contractor_
nse Holder
STATE OF FLUK , ILIA
90
e of
e of sworn to (or affirmed) and �subscribed before m
Sworn to (or Ormed) and subscribed before m Physical'Presence or Onlihe Notarization
e Notarization 20Z0 by
NamdOfpersoii making statement.
Name mpo,""Ill. ~.o'_
-_--
Personally Produced Typeof Identification
uKnuwn____--QR
BY
-RECEIVED
Personally Known` ORProduced Identification
__-_-_
Type of Identification.
ProdurN
'C MANGROVE
PLANS EVIEW
EVIEW
rs
OWNER/ to - NTRPiCTOR AFFIDVIT: Application is hereby made to obtaln,a permit to do thewos
.
-itatibri,that is granting a permit will auth" 6ts that may restric(Or pr hit
asA�ent�xWwner
|� \ S�natureorune/^e""~~ Contractor_
nse Holder
STATE OF FLUK , ILIA
90
e of
e of sworn to (or affirmed) and �subscribed before m
Sworn to (or Ormed) and subscribed before m Physical'Presence or Onlihe Notarization
e Notarization 20Z0 by
NamdOfpersoii making statement.
Name mpo,""Ill. ~.o'_
-_--
Personally Produced Typeof Identification
uKnuwn____--QR
BY
-RECEIVED
Personally Known` ORProduced Identification
__-_-_
Type of Identification.
ProdurN
'C MANGROVE
PLANS EVIEW
EVIEW
rs