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HomeMy WebLinkAbout Building Permit Application I All APPLICABLE INFO MUST BE COMPLETED FORAPPLICATION70 BE'ACCEPTED Date:. - Permit,Number: Building Permit.Application. Planning.and Development Services Building.and Code Regulation Division` Commercia_I Resid:enti8l i 2300-Virginia Avenue;Fort Pierce FL 349&2 Phone (772)4.62-1,553 Fax:(772),4624578 CBDG Funding PERMIT APPLICATION fOR: - Address: 67- Q CS C - Cl 4xs C1F� r F;32-( -P(C-a.c5',, 3Y�iS'1 Property Tax 1Q#: Llf £�d6 Ua sl a'n trot No. -?, 8. Site Plan.Name:` Block No. Project Name: DETAILED DESCRIPTION,nOF U1% %ORK.< z t �<x la:�.S7/tC-L TIC_: . t.,..lr•!r .vl .per-�ls�C'la d��t n� �"7yc _ I I _ New taectrical.Meter Second ElectricafMeter (Affidavit required) CC?NSTRUCTION I�NFORIFlIATION z . Additional work"to:be performed underthis•permit-check all'that apply: I Me.chan,ical Gas Tank Gas Piping r;.Shutters Windows/Doors Pond- -- - _Electric —Plumbing _Sprinklers _Generator Roof Pitch. Total Sq:Ft of Construction: -I -- , Sq.Ft.of First`Floor... Cost cfconstruction;$ Utilities: _Sewer .. Septic Building Height: �tn��IER/LESSEE. 4a< � OITRACTOR *.x. - e Narne_,� �.JS`� Name:.`jLb -t S'r7o A- s` Address: 523 c a►Ct CA-V-C- CtdL 'Company: i�rc 1N tom.t� i city.— 'State: E Address: S!'- 3 S�J `i oc.(-!-,< 2 . Zip Cade;. 3 Faii:i cl 2 -r-1- Pho<ne No. `�I` - -7.50 - - ty:,`1�6� - State: t . t E Zip Code: 3ySs3' Fax: Mail e M; "" Phone No:- 2 Z F.oin;fee'simplerTitle,Holderoninextpage:(ifdifferent. E-Maim from the Owner listed above) I State or County'License._'4*3 CSC ` i of value of construction is4500 or more;a RECORDED Notice of Commencement is required. 1f value of HAVE is:$7,S00:or more,a RECORDED Notice of Commencement is'required. - I � PID)ESIGNER&ISIGINEERt -Not A ,i cable: -M_ MM;. RP MORTGAGE"COMPANY: ,_NotAppiicable Name. Name: Address:. Address: Ci tY State:;. C[ty. Stales Zlp: Phone zEp: Phone: FEE'SifVti'LE T1TLE'HULDER _ Not Applicable. KOND[NG`C MPAIVYs Not Applicable: Name: . Name: --_ Address: Address: City': City. Z!p:. lstione:._ Zip Phones OWNER/CONTRACTOR Ot l : :AFFtQVtT:Appbeatdis- herey ade,o obtaina.permit•todhework andinstallatio i certl/thatn fas'indicated. 6 worts or installation has commenced prior.to the issuance a permit:. t St;Luck t ounfv makes no representation that ltgranting'a permit will authorise the permit holdef'to'buitd the subject structure. i which is in co, ict with any applicable Horne QWfiers Association rules,,bylaws or'and covenants that,mayrestrtct or prohibit such i structure.Please;consuit with;yd. ur Nome ownees;Association i d.re I&v your deed fo.any restrictions which may apply. i (h consideration,of the graniii_ng of ttii requested permit,i da hereby agree that t;wtti;,in ati respects,perform the work' t it accordance withthe appi•aved plans,the Ronda.Buitdiog,Codesand St.lode totintyAmendments, t _ The follovVingbuilding permit applieationsare exempt from undergoing a full'concurrency:rev ew::room additions, accessory structures;swimming pools,fences,waifs,tigns,screen rddms and accessory uses to another non-residential use i WARMING TO-OWNER:Your,failted to,Record a:Notice of C©miriencernent may result in.you"r paying.t�rict:fot improvements to your property,A Motice.of Cammeoteinent must lie re`cd"rded and,posted on the,lobsite l?e€ore the flint-inspection.tf you intend taobtain f nancing,consult-with'lender ar an.attorney:bafiore I commencina Work or recordin our,Notice of Commencement. { J Sig tune of Owner/Lessee/Contractor as Agent.for owner Signature of Contractor/Ucense Holder i STAi E O LORl A STATE mF F-LOR[DA:- CoLl Y 6F�[ .-! CQtllitTY op ` h tcn Q t . The.fargoing instrument was acknowiedg efore me The forizoing instrument was.acknowiedge efore;me l this ifay'of' _: 20o y this day of —C `1 2oy F (Uaiioe•of person acknowledging). (Name of persott acknowledging') s (Signature of ary P, btic:Slate of F dal ., (Signature of Nota u lic State of F.ta ) ti ��.OM Ettiii#ttiy►Af Personally Known'. QR Produced Id FfrsaraRy&sown- OR Produced Ic��[1@alc fiEs Type of tsientification w `� t�' ' '' i� lJe of Identification (} Produced'.. .. ,,`��3 �p � PAuced. .. .. �� rs�y252 f r.., '• - 1 Comtnissien'No. ssionNo; rSaf� GG3$iM <��'�" !,✓a"�,'��'�da41�r�� rJ",w� REVIEWS FRONT [ ZONING < IANS VE�i CATION, 5EA.TURfh� • i4.C. �' GAUNTER =, REVIEW off, ` ;����, REVIEW REVIEW RE1ftEVtC r DATE lint#; i RECEIVED DATE: COMPLETED t ev.717014 i -