HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO DE ACCEPTED
Date: _ hCV fTlll Nurnb t .
Building Permit Application
Planning and Deveiopmen r Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
JPROPOStP i,l'1/I
4t
Address:. —
Property Tax ID #: _
Site Plan Narne:
Project Name:
New Electrical Meter
MENT.LOCATION:
Second Electrical Meter
GO 4 -
N$TR.UCTION [N1=O W ION:...
Lot No,
Block No.
Additional work to be performed under this permit-- check all that apply:
Mechanical — Gas Tank _ Gas Piping r Shutters Windows/Doors _ Pond
_€lectric _ Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq, Ft of Construction: IUD Sq. Ft. of First Floor: _
Cost of Construction: $ -+-. 000 _ Utilities: —Sewer —Septic
Building Height:
OWNER%L'ESSEE
CONTRALTO R
Name . 1611
44M.y.
Name:
Addre 4ff
Company: wTLI 6
City: State:EL
Address:
Zip Code: Fax:
r-�
City: State:rl
Phone No.
Fax:
Zip CJNo
E-Mail•
PhonFill
in.fee simple Ti le Holder on next page (if different
E-Ma� M
from the Owner listed. above)
State or County L tense k
If value of construction is 2-500 or more, a RECORDED Notice Of Commencement is requires.
If value of HAVC. is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN UAW INf
6d1-G LA%tNGINELN;Nu1 NppilI- J'jC
Name: {t.I,ad M%
AddtcsS: +nv v �M+�►ana�,wl ttir. o.H
City. I%w%w __ Stata: au
zip: phunexu.uIsm
FEE SIMPLE TITLE HOLDEI1: Nut AppliLable
Name:
Address•
City.
zip. Phone,
011MATION,
MuItTGAGt. COMPANY' _-riot Applies Me
Addict S'
City:_
7)p;
BONDING COMPANY: ___ Nal ApplscAk
ddiI
Addrtcc
City.
Zlp: Phone:
OWNER/ CONTRACTOR AFFIDVIT. Apphutlon S hereby made to obtain a permit to do the work and Mst:lladoM ss 101E:ca"
I cerllk that no worst or Installation has earrenenced prior to the b;uancs of a permit.
5 Lutk Cvun ms!Stut0ur
no rlepreser�tt�ptlon that is gantlng s ppeermit will authorkeerthe permit hddtr to bad the s+rblect structure
v Ir}s Is in S i twaap Iii Hama Owner Association rule##,, byliursds t(r0 covenants thsz may ie kdr nr pr It swh
t tructtlre. fgease carh Horne Owners Auotlattcn and review your ert for atsy rtsvlcdans V0v may s03
In consideration of the granthw of this requested permit; ) do hereby agree that I wHI, in Wj respea% perform the wok
In accordance with the approwa plars the Florida 8 AWr%a odes and St. Lune t ourrW Arnendnstnts-
The fonomm bugdiF4 permit Applications are ess rnpt from wWerpind a ruli vo+iummV review. room odd'nlam
accessory strucb ve% swtmmtry pool; fenm& waft sl4 scretn roams and ai=swry uses to im0d r nsn residendal use
WARNING TO OWNER: Your failure to Retard a Natin of Mtt macemM may Mutt in goyim Dow far
Improvements to your Property. A Notice olCommencement must be recorded In ihr vubllc records of 5r-
Lucie CourdV and posted on the jobsite before the first Inspectloirk. Ifyuu intend to obtain financing, consuf t
with lender or an attorrtetr before commendrw work or recardirt your Notice of Commentemerrt•
SiRrtatetrbOfOwrW/L&=e/Can=cWrasAgierttfar Owner ScSna=areat usaorr a�o�+�
STATE OF FLORIDA STATE OF COLORADO
COUNW OI ; COUNTY OFF
Sworn to for affirmed) and sitWbed before me of
or N OnIrse Notarisation
this datrof 20* by
KnMn ,._ OR Produced tdendfktabon
Type of
Cnmmissidn Ha. v t (Seaq
REVIEWS FRONT ICOUP ER ON
Swann to (or aftlrme4l and subscribed before meat
x pl Preserrte or online Notarization
this of A4W • 1020 by
Hama of pawn
Type of
Knotvrr x OR Produced
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PLANS VEGETAi1ON SFATURTLE
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