HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE IN O MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /� �- 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:
Address: / �"'' r/Ga +� (S . %.-
Legal Description: al�
fit% KQ .t/ - 71 S
Property Tax ID #: VEY —600 Lot No.—�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: — Right Side: Left Side:
Additional work to be performed under thls permit - crnecK all tnat apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: —
Cost of Construction: $ Utilities: —Sewer —Septic
_ Windows/Doors
Roof Pitch
Building Height:
i
Name°'R` % s »' i (t-)e-
Name: " C% -Cry
`
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Addree FCftl6
CompanVi _ r I"V iU. hs
City: ` !� 1- c E e State:
Address: �� "i'io r-
Zip Cocle2yC: Fax:
City' /� et'4e
Stater,
Phone No. `%"7 (o e ��
Zip Code: Fax:
E-MaiI: za 'e761i
Phone No 270
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
As of January 01, 2020, Any and all notarial certificates prepared under Florida law must indicate
whether the principal appeared by means of physical presence or by online notarization. Florida
Statue 1-17.05
(a) For an oath or affirmation:
STATE `Of FFLORIDA
CO
OF`
Sworn to (or affirme and subscribes before me b eans of hysical presence or online
notarization, this day of�(%) gt 'f (name of
person making statement).
Personally Known OR Produced (Signature of Notary Public - State of
Identification 1 ype of Identification Produced Florida) (Print, Type, or Stamp of Notary
Public)
®q3Y Notary Public State of Florida
(b) For an acknowledgment han individual capacity: Melissa L Butterfield
y _ o My Com30 mission GG 2065
V,' "Q#7 E<c,ires 02/14/2023
STATE OF FLO A
COUNTYOF
The foregoing instrument was acknowledged before me by means ofhysical presence or online
notarization,
This ,4 day o&4,-� '' ( b (,�% L 1
Y {name erson) as (typ f
authority, e.g. officer, trustee, attorney in fact} or (name of party.on be alfo whom instrum nt vas
executed). ,.. n / J ,
Personally Known OR Produced�_�/
Identification Type of Identification Produced atu e of Notary Public - State of
Florida} Print, Type, or t m of Notary
Public)
2a0j7 ° Notary Public state of Florida
(C) i=oran acknowledgment ins reoresenfativecanacity- Melissa L Butterfield
�a My Commission GG 302065
E.:;,ires 02/14/2023
STATE OF FLO A
COUh1TYOFr ii%
The foregoing instrument was acknowledged before me by means of physical presence or online
notarization, —
This day o"i�( IA4by j — (name of person) as (type o
authority, e.g. officer, trustee, attorney in fact} for (nameofpartyon behalf w om instrume w s
executed).
Personally Known OR Produced
Identification Type of Identification Produced (Signatu a of Notary Pu lic - State of
Florida} (Print, Type, or Stamp of Notary
Public)
oyr °t Notary Public State of Florida
Melissa L Butterfield
My Commission GG 302065
'$j�yE=,,ires02/1412023