HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
Building Permit Application
Planning and Development 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:
Y
Address: 143 1?e.r2PDer Ln ( FMC11 rl 3g5-1
Property Tax ID #: c Zt j • ,5d,-_� , r�D12 • CY O. 2 Lot No. Co
Site Plan Name: _ exx, +r-eC✓ L&+-1.y Block No.
Project Name:
19 (7 0ILlcr- 12 ' z -/, - - - 1 4 C) c �) wE
71 :�E i u u-1. i q
New Electrical Meter Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters 4 Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ • C:1�
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name Wid- d QJ bOn,3d
Address:51 C-71rAc12 V_rA
City: 3--S i D State: Nei
Zip Code: 1`1_C�)1 Fax:
PhoneNo.'02'� •�lC�-1. 12��C7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Cnnnie- C-innce..
Company-, 1� C--,CarC►Qg 60()fv-
Address: W:,' B�Lrterpdsc, Dc
City: Pbf+ _1�1-- U_Lc_i-__ State:FJ
Zip Code: 34Q'96 Fax:
Phone No -_M • 4toO
E-Mail �cusv e DDhnrcaacci006s Psl - com
State or County License 31 �2l
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirm�eD {{e�nd subscribed before me of Physical Presence or Online Notarization
this 2-0 day of EJ5) 20,af_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- �tate of Florida )
c�G ]
Commission H
MICHAEL WALZAK
No. (Seal) *
Commission#HH067991
+� �e E)Ovs February 2, 2025
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�,dr'
ioMN tIw turp�tNwry Servkes
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5720/21