HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAa APPLICABLE INFO MUST BE CO14ir6.TED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
M
NNEU
NO
.. 8. CEIVED
Building P� rmit Application. 2ot�
Planning and Development Services R 2 9
euilding and Code Regulation Division �uc�e County, Permitting
2300 Virginia Avenue; FortPierce FL 34982 S
Phone! (Z72) 462-.1553 'Fax: (772) 462-1578 Commercial -Residential X
PERMIT APPLICATION FOR: To. Select from�Iropbox, click.arrow at the end of line..
PROPOSED IMPROVEMENT LOCATION.
Address:-)aa-S PU7I S+ .�.a �1- W cig(o
Legal Description:
Property. Tax ID #: `z '�� �1 ' om• Lot No.
Site Plan Name: Block No.
Project Name: n-• D. " �J . .
Setbacks' Front _ Back: Right.Side: Left Side:
DETAILED DESCRIPTION OF WORK:
S�,1e-ems IDscon'
CONSTRUCTION -INFORMATION:
A210I - .
itiona -wor to: jje��e orme un er t is permit — ec a app y:
EHVAC LJ Gas'Tank Gas Pipin� Shutters .
Windows/Doors.
ElectricPlumbing 0Sprink'ler Generator .0 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ �10��. �(� U ilities:cnSewer Septic Building Height:
OWjER1ESSEE 1 CONTRACTOR:
Name Name:
AddreConipan `� �(t5i�'
L
City: l State-( Address:
Zip Code: Fax: city' fv _
ytJU1�. State: FL
Phone No. Zip Code: 3"�32: Fax: 407-847-9342
E-Mail: Phone No. 7727777-8655 -
Fill in fee sirr�Ole Title Hold on next Page (if different; E-Mail: , craigmaccoy@america-pools.com
fr®rn the Owner, listed above) State or County License!, 30OG6
if value of construction is $200 or ree®re, a RECORDED Notk of-ommericement is, required:
I�
S, .-P�LEME'NTAL`'CSONSTRUCT LIEN LAW 1'NFORMATIOW'
DESIGNE E IN R: Not Applicable MORTGAGE COMPANY. Not Applicable
.Name•.. ws ' 2fiflfl.
Address:..' ;
Name*.
Address:
City.: O. State:
Zip:.+ �. Phone:
City:: State• '
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not = BONDING:.COMPANY:, . Not Applicable:..'
Name:.
Name:
Address:..
Address:.
City:. .. • , ..
Zip:
Phone
.City.
... .Zip:Phone:..
I certify thatno work orinstallation has commenced prior t the'issuance of a permit.
wh ch is in to County
, is makes
no
repreic nt tion that, is granting a gqerrriit will authorize the, permit holder to build the subj ct structure
e Home Owners Association. rules; bylaws or.and covenants that may restrict or prohibit.such' structure..Please con sultwith.yourHome Owners Associatio' and review yourdeed for'any restrictions which may apply.
Inconsideration of the:granting of this requeste I rmit, l d .hereby agree that I will, in'all respects, perform. the vrork. .
in accordance,with'the approved plans, the Florida Building: odes -and StAucie County -Amendments:
The.following building permit: applications are exempt, from." ndergoing a.full concurrency review: room additions;'
aceessory:structures' ,.swimming pools, fences; walls, signs, s reen rooms,'and accessory' uses -to another non-residential=use
WARNING TO OWNER: Your.failure to Recoid a'Notice of ComMencement may result in your paying twice for
improvements to, your property. A Notice of Com. encement must berecorded and posted on the jobsite
before the first inspection..lf you intend: to obtain . financing; consult with.lender or an attorney before
commencin -work or recocdin our•Notice.of Corr�mencement::.
U1
SigTra uf`Fe of Owner/ JContractor asAgent for Owner Signature ntracto /L ense Holder
S
•
STATE -OF FLORIDA STATE.
COUNTY -OF lhdian River, :. ...FLORIDA
• COUN OF indlan River . .
The r ing iristru t s tknowledge' efore me The for Ping instrument was acknowledged before me-:
dig � •
G:. rr�j��� �u
this day of /V� 70� by :.. this.�d6y of
. . .. . . .
. 2 y :. .
(Nam erson acknowledging) (Na rson acknowledging )
(Signa .. f- otary ublic- Statepf'Florida . -(Signatu f.Nota fy P blic- State.of.Florida
Personally Known OR Pro 5ed ntification Personally Known OR Produced identification''.''
Type of; Identification Produced '
}-' Type of Identification Pr uced'
Commission CraR� Emmett! IV1aaCc
eal) Commission No..
..
q' PIi9LIC:
(Seal)
STATE OF, FLORIDA Craig Emmett! Matte` y
.. Revised . 0 Wires 5/28/2020 . .
�= aTATI OF FLORID? : -
REVIEWS. - FRONT ZONING SUPERVISO : ..PLANS VEGETATION. SEA TURTLE' MANGROVE
COUNTER.' REVIEW :.,REVIEW' --REVIEW `REVIEW REV
REVIEW -
DATE . '
COMPLETE.
.INITIALS . _ • , :.