HomeMy WebLinkAboutBuilding permit appAll L 1 BE 0 M PLETED FO R A PPEI CATION TO B E A CEPTE D
Date;
APP
P— e:rrnit Number:
LL! L�L L
Building Permit Application
Plarming and Deveiopmenr Servire.5
6�1ifding aad Code Regulation Division Commercial #
.2 Vrrgraia Avcnu--r .P0rt pierce FL 34982 � ���I{� �F#�i��
Phone: (772) 462-1553 Fax: (772) 462-157$ ClBDG Funding
..,...........................
i PERMIT APPLICATION FOR-: -- —
I PROPO D IMP VE i T ION:
i
Address. -
Property Tax RED #:
Site Pdan Name-
Lot No.
Block No.
Project Name,
D TAILED DE CRIPTION OF WORK: -
New Electri-cal Meter — � Secofld El-ecirical Meter
LCO NSTRUCTION INFORMATION:
dd- onal w-Drk to he Perforrned under this permit — check all that apply:�M cheni�aJ : Gas Tank _ Gas Piping Shutters
(Affidavit required)
W i r1dows/Doors Pond
Electric — Plumbing : Sprinklers
Generator � Roo f Pitch
TWA Sq. Ft of Constructi
Sq. Ft, of F rat Flee#;
Cost of Construction: W Utilities; _Sewer _ SepticQWNXBuildi� Ner t-
RE EE: CO TITOR: -SrY�
e
i
I city: State:
HC
Zip Code: Fags:
Phone r
Fi I I i n fee sirnp le TIM a Ha Id er o n next p age (if different
from the Ow ne r i iste d a beve )
If value of construction is 2500 or more,
a RE -CORDED Notice of Cvi
tf value of HAVC is $7,500 or more, a RECORDED Notice of Oornrne,
Name:
Cornpan
Address'
City;
Zip Code'
Flhone
E-M ei l Y ' o nre
State -or County L ens
'nmencemertt is required.
rice rm ent is required.
Fad
SUPPLEMENTAL CONSTRUCTION LEN LAW JNF kT
�E5 O�N _
IJNr-II tf C1NEiER- Not �i able
Name; lTE CIpAN= Not Apl iabie
Address; Name; —
City: Address:
Zip: 5t te; City-
_ State- _
FEE WAPLE TM F unii men
4 Name- Not AppliCabje
Address;
City:
Zip, Phone,
IBONDING I11+1PPANY+ --- Not Appli�
Narne: able -
_
Address -
City:
OWN ERA
p Cif' i fY tot 00 WOr k or 1 nit alldt I on h as Cam fted w �d� �� �I����� � F�4 t� �o the W oric and I �1'i1 �Jl�ll�r7 �� I � I��[e �
�ri�r [o the �s�fr�� �f � �`rrr+it.
which. St ie ts�w r� no re ntat,orr that a� rarw �
+ �C k} 1# w4�I�fS wSmcwion r ' r Iw'jl ia�r� �'o�deF to b�,pid t 5�I Jac! structure
s+tru[[ �,re i Cerlsult h yauf �i , I � tit r r
ti1rR?�F +4 o[�a ltCq�1 Qmd reVre* VIOW d■�d folr arr r tra l i�ri Which a h�b+i s� h
In HE
Consad*ratiort of tlrrr gran[ir of tFlis requesIed P&rn- t i d- Y lxv 1+
�n mmrdanEe with the aP' d Rl11�hsr ttW Fiof4& RUilci her w +'+ex [��t wialr in JW resPeCbp Ptr wrn tihe work
Tie #ol f iond St Lr Lou rkly Amend ments-
�wltrr� �+upl�hFti$ permit � Pi�ii��1 ip ns a r@ ftrr�
aCI�s3 a t fp• r[r u er$orp Pull cOnguFren review : room additlaF��,
orlr t��lur>r. sv�nrrnrti#aIss++1, rr�alM� 5r12n!, Irr&nm f
°'ate 11 n+d #CCei ut R 0 arl0th@r ,on . FfliCen t .41 US@
WAR NICI TO OWNER: YOUf failur* to ReCord a Ngfica ° � ce ent may result
ampro�rernents tO �ro�lr PrOper- A Native of �ornmerlcement �1+1ust be ��d pa
r�1� t��I �#�r
Luele County and posted on tF�e jabsite before the first ins � e��r#� o� fit.
wi t h lender o r a n attor qt before Com rnen-cii n work or record you
ricend to � m r� rr f I n� n �� n� �� ItI.
_ L w, tiauiir6r i{ S4f jj'j Awt rof 7jw
STATE OF FL
i
COU NTVall
n to tCW a#11ra a nd su Gszr ibed befo+e M e of
this day -of 20 24 by - Physical Pr r ar
N.�rnLm OfPea50r, rrr4kpng -%txt$P+t.
Perlon.oll* Kn OR Prod-uled IdemifwAt,
T� ntiifk�� produo
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