HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date- Permit Number:
Building Permit Application
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Building and Code Regulation rsIon
2300 Virginfa Aventie., Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 commercial
PERMIT TYPE..
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P � perty lax ID #W 3yr-)
2.. Loor Cof 660 Lot N a 0�
Site Plan Name
Block .
Project Name:
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Additional work to
Mechanical
1000080"�
E lectric
WEEEMM�
be performed under this
permit
— check
all that apply:
MWENEW Gas Tank
� Gas
Piping
_Shutters
Tc7ta1 Sa. Ft of Construction:
Ca5t of Con5truction: S
Plumbing
a
Spr I n kle r5
Generator
Si
im r
--Wfln
iJ`Ij� W.✓ �,
W-Indows/Doors
MEW
Roorf Pitch
Sq. fit. of first door:
Uti fities: !Sewer � Septic Bul1ding Height:
1W I ". I ; - . -1 ; '.�o
Name <WX0.0001 in
� Address > C.�g Y
' CO-� � �" �se�, c.0 State: %:/7
VPLWI
Zip Code: 3 OU Fax'
Phone No.� Si5w ?50
E-Ma-1- n2y
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� Curnpany�je
Address%
I City:
IV.
Zip Cody: '
Phone No
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State,
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rill in see impie i rule nu�el on � 1 19c;..from the owner listed above} �� ,I+�`�'` � �""� State v� County license s
..
If value Of construction i5 $Z500 or more, a RECORDED Notice of Commencement is requires.
if value of HVAC is $7,500 or more, a REGGRDEU Notice of Gamrnencemenx is required.
DESIGNER/ENGINEER:4
Narne:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _Nat Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Applicable
Name:
Address:
City. Stateo-
zip: Phone:
BONDING COMPANY:
Not Applicabie
Name.
Address: i
City: �
dip: Phone:-M..
OWNER/ CONTRACTOR AFFIDVff: pl i cation Is hereby made to obtain a permit to do the work and installation as ind'cateC
- t that no r r i l t'f-r ri r issuance f a permit.
bulld thesubject structure
1 �,.� '-T'i r r'1tation that i ran in a permit 1 i�1 L�J r"Tl restrict 13r �ilbit such
t. Lug, - p �ttr rules, lags r are cenan that a
n icy i in coy tct with any applicable Home Owners Assoc maY ��� .
structure- Please consult with r Home owners Association and reef your deed for n rest� ion� h �ch
- i��� � ill In ��l respects, perform the ��
nconsideration of hgranting of this requested permit, I do hereby agree t
Floridain accordarce wrth the approved plans, the Build(-ng Codesand St. Luce County Amendments.
T� following bui l i n permit applications are mpfir undergoing oil a Trull or�curr n review; room i i�� �
.�truacces.so s �,� r`r+t� r ���� ��r+c�� vial I , i�1 , ran roo a
nd accessory L;ses to another non -residential use
ry ENT MAY RESULT I P ING
A R N I1 T OWNER # YOUR F I MUff MUST B RECORDED AND
DICE FOR IMPROVEMENTS T YOUR PE P
_ iJ
inn T OBTAIN FINANCING,CONSULT
POSTED THE JOB SITL
W LENDER OR AN
D'
ADO RIB � kDV. r IR TICOMMENCEMENT
5 �a[ure of Owner/ Lessee/Contractor as agent for Owner
STATE OF FLO
COUNTY OF
7h f�Ong insr was acknawled�befo
re me
�thi�,of L2kY
n rrA n gr st zi t e m en t.
r 1 1 F,
zg an ure of Cartractor/Ucense Holder
STATE OF FLOR
COUNTY OF
The fg instrument was acknowiedg pefore me
thisINa of �t� 20by
• N6 l&, rli%oa r-h- r,\ 01
Name of person making statement.
Per5o����y �Ro�� �R Produced Identification V i Persarrally Known OR Produced Identification
Type of Id�ntiric n lde�!tifitio? - T)� -, IMA kftlftl U e%-AIRI f9WC1 L! ed b
k-<
qm
Produced k I MONOUE hL CARLOW
N@W90 , Vits cf da
-T es ;wry PUbjliC. W Of Rom(
* , GG 8 �.
#�am- 4�pft Dot 10. Corilmissicrs GG 2E9499
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(S-gnatLre of i'
tart' public- state or Fir-
Comrniss+on No
(O:G )t q r, I
DATE
R FCFIVFi]
maviuml
(seal)
(Sign3ture of Notary Public- St
e'en m mircinn mn
(Seal)
f - • r ,f ; -0. - . - - :
REVIEW