HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c1 16 a1 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
PROPOSED IMPROVEMENT LOCATION:
Address: Zi0o
�a� Qi w 3Ljq`a2
/"5
Legal Description:UM % Fisja;tv-`51 u I-" ( B1 V— (-% tgj—.3 /
Property Tax ID #: U7-1 - (r o l - 00 25— 00 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
U r Luce: ywstul( new ? a.5 ton / 15.5 Seer Heo,+
a�n„p Ale, 5?VI+" Sc Stim Laty\ 5 kip — h eat-
CTION INFORMATION:
CVAUC
or to e e orme under this permit -check a app y:
O-GasTank []Gas Piping Shutters QWindows/Doors
Electric Plumbing Sprinklers Generator O Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
lSewer
Cost of Construction: $ Utilities: Ij Septic Building Height:
OWNERXESSEE:
CONTRACTOR:
Name
E �1 Si
Name:
Address: t5 r�
Company: l
�.
City: Pitf`�C�� State: FL
Addre!sss:51
City: YDrb— lRp rcei State:
�a�hfl'
Zip Code:
Phone No. / i%q- 982 0
Zip Code: 3"5 1 Fax: 71;-- 4&tP-.373'7
-9+
E-Mail:
Phone No. -rig- LUAI-4I-4.1
Fill in fee simple Title Holder on next page ( if different
E-Mail:
State or County I icen e: CAC 18I S 13 lD
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL COINSTRUCTION LIEN LAW INFORMATON,
DESIGNElt%EEGHM'S : _ Not Applicable
Name:
MORTGAGE ANY: _NoiApplacabie
Name:
Address:
Address:
State:
Zip: Phone
City: State:
Zip: Phone:
PEE SIMPLE TITLE HOLDER- � Not Applicable
Dame:
BONDING COMPANY: Not Appricable
Name:
Address:
Address:
City
City --
Zip: Phone:
Zip: Phone:
f 1 iT. rYf t w=.J ii J� f 1' 1
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In consideration of the granting of this requested permit I do hereby agree that l wilf, in all respects, perform the work
in accordance sal the approved plans, the Florida i wWtng Coda and St. Ude County Amendments -
The following building permit applications are exempt from undergoing a felt u3neurrency review: room additions
accessory structures, swimming pools fences, walls, signs, screen rooms and aCcessary uses to another nonresidential use
WA.Rft ING TO OWNER: Nbur faffure tollectud a Notice of Conamencenient way result are yimw paying twice for
improvements to your property: A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an atfor nev before
7' Agerti for 00,x- :;Pe,
-�
S%naturea~`4iCer/ tesse CDntraCtoewrier Srgnatumof ContachorJlicense Holder
FAVE 1111k artr r
The fprgoitg mns entwas acknowledged before me
this I h dayof�f0.7jk::� 20-IL by
Mdiae t F Say le,
Name of persm/nalting stAtement
Personally Known OR Produced klesuifi crn
Type of identification
Produced
(Signatureof Notary
Commission 'i�;., CHRISTIN€
61- Luc, z/
The ing" f t was acksrawledged before me
this day, of lqW-4 21 91 by
WcW F &Ieo
Frame of persoyinalding statitment
Personally Known V OR Produced tdeatfificanon
Type of klentifietion
Produced
y,q,. Commission N GG 96470'ur My Comm. EuIs
plres AuE 421, 2014
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REVIEWS ZL3'idll7G�x SUPERVISOR PLANS
OUNTER REVIEW REVIEW REVIEW
Lev.
Notary Public - State of Florida
Commission 8 GG 48,701