HomeMy WebLinkAboutBuilding Permit Applicationttx I ttI Nt,
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CONTRACTOR:OWNER/LESSEE
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State or County License
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Company
Name:
Zip Code:
Phone No
Add
City
Fill in fee simple Title Holder on next page (
from the Owner listed above)
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if different
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AIIAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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4l-'vr-U Permit Number:
Date:
Building Permit APPIication
Ptonning and DeveloPment Seruices
Buitding and Code Regulation Division
2300 VirEinia Avenue, Fort Pierce FL 34982-pn""i,
Qtzl 462-Ls53 Fax: {7721462-t578
Commercial Residential v
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Address:-c - ec0 Lot No
PropertY Tax lD #:
Block No.
Site Plan Name:
Project Name C
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New Electrical Meter Second Electrical Meter.
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank
-
Gas Piping
-
Shutters
-
Windows/Doors
_ Electric _ Plumbing
-
Sprinklers
-
Generator
-
Roof
Pond
Pitch
Total Sq. Ft ofConstruction Sq. Ft. of First Floor:
Cost of Construction: 5 Yq, ouz)*Utilities:
-
Sewer
-
Septic Building Height:
lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required
PERMIT APPLICATION F OR:
N0TINTELOCAPRMOVEMOSEDROPP
lf value of HAVC is $7,5fi) or more, a RECORDED Notice of Commencement is required'
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of Owner/as Agent for Owner re of
STATE OF FLORIDA STATE OF FLORIDA5++COUNTY OF 9r COUNTY OF
Sworn to (or affirmed) and subscribed before me of
,Y py,rt;."' Presence or Online Notarization
thEb-day of Decza,..J)en . 2020 bY
Sworrlto (or affirmed) and subscribed before me of
TPhvsical Presence or
-
online Notarization
tti" -Aday of Da-ol .-Qu. " ,2020 bY
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Name of person making statement.
Personalty Known l./ OR Produced ldentification
Type of ldentification
Name of person making statement.
Personally Known -{o*Produced
ldenfifi cation
Type of ldentificafion
Prod
(Signature of Nota blic- State #HH (Signature of Notary Publ oi I #HH
Expires 0ctober 29,(,i Erpircs October 29,
Commission No.rl.iLt 3Gt OF mission No.c;)q3 ry'*
MANGROVE
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
ZONING
REVIEW
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
CTION NLIECONAL LAWPLEMENT
City
Phone
Name
Address:
zip:
MORTGAGE COMPANY:
-
Not APPlicablee
State
Pho
Name
Address
zip
City:
ENGINE ER:DESI
-Not
APPIicable
7ip:.
Address:
Na
BONDING COMPANY:
-
Not ApPlicableFEE SIMPLE TITLE HOLDER:
Phonezip
Address
Name
INFORMATION
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